Endocrine Abstracts

Introduction: Precocious puberty (PP) in boys merits a thorough clinical review as an organic cause is more likely. This case reports an unusual cause of PP.

Case Report: A 5-year-old boy with a background of prematurity presented with PP. There was no family history of early puberty. Central PP was confirmed by a luteinising hormone-releasing hormone test (peak LH 5.8iu/l and FSH 3.0iu/l) and further investigations were performed (table1). He was managed with 8-weekly gonadotropin releasing hormone analogue (Goserelin), which was increased to 4-weekly secondary to aggressive behaviour and detectable hormones (table1). A discrepancy was found between venous and capillary testosterone levels raising the possibility of exogenous testosterone exposure (table1). The safeguarding team supported discussions with contacts, including family and school staff, but no history of topical testosterone was identified. Anastrozole and Bicalutamide were introduced to reduce synthesis and action of testosterone as his symptoms could not be controlled. Continued efforts were made to find an extraneous cause of testosterone. The patient’s father, who was not living with him, but had daily contact informed us about his transdermal testosterone therapy. He then voluntarily switched to parenteral testosterone to minimise exposure. Anastrozole and Bicalutamide were discontinued and Goserelin was reduced to 10-weekly, with an improved clinical trend (table1).

Discussion: This case highlights the importance of considering unusual causes of PP. Transdermal testosterone transfer occurred despite clear patient information leaflets and precautionary measures. Regularly educating patients with the symptoms that may occur in contacts during accidental transfer is essential. It also highlights the need to obtain information from all family contacts as this may not be readily known due to it being confidential and sensitive in nature.