Background: A 5 years and 10 months boy presented with pubic hair, recent penile growth, aggressive behaviour and rapid growth of height. Antenatal, perinatal, and developmental history was unremarkable. There was no family history of precocious puberty. His height and weight were 128 cm (2.24 S.D.) and 25 kg (1.55 S.D.) respectively. Vital signs were normal. He was Tanner 2 for pubic hair and his stretched penis length was 11 cm, right testis volume was 5 cc and left testis volume was 3 cc. His bone age was advanced to 8.5 years. Serum total testosterone level was elevated (150 ng/dl) with prepubertal LH level (<0.2 IU/l), other laboratory results were DHEAS: 66 μg/dl, androstenedione: 2.10 ng/ml, ACTH: 16.2 pg/ml, kortizol: 6.7 μg/dl, 17-OH progesterone: 0.9 ng/ml, TSH: 1.42 mIU/l, and fT4: 0.79 ng/dl. On LHRH analog test, peak LH was 1.35 IU/l. Cranial MRI was normal and a prediagnosis of peripheric isosexual precocious puberty was made. Abdominal MRI was normal to exlude adrenal tumors. A scrotal ultrasonographic scan showed a heterogeneous mass lesion with heterogenous vascularisation on doppler, in the right testis measuring 23×12×8.5 mm. Left testis was normal. Pelvic MR showed a mass lesion in right testis. Tumor markers including β-HCG and AFP were negative. A diagnosis of isosexual precocity due to testosterone-secreting testis tumor (Leydig cell tumor?) was made.
Objective and hypotheses: To attract attention to Leydig cell hyperplasia which should be kept in mind in the differential diagnosis of testicular tumors.
Method: Case report.
Results: High inguinal orchiectomy was done. As a result of histologic examination, a final diagnosis of Leydig cell hyperplasia was established.
Conclusion: Nodular Leydig cell hyperplasias are very rare during childhood and may present with peripheric precocious puberty. It should also be considered as differential diagnosis of testicular masses.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology