ESPE Abstracts

Introduction: Precocious puberty in males is less common compared to females and an organic cause is more likely. Therefore, a detailed clinical review is crucial to identify a diagnosis. Our case highlights an unusual cause of precocious puberty.

Case Report: A 5-year-old boy presented with precocious puberty. He was born preterm and had cerebral palsy and attention deficit hyperactivity disorder. There was no family history of early puberty. A luteinising hormone-releasing hormone test confirmed central precocious puberty and he was further investigated (table 1). He was treated with a gonadotropin releasing hormone analogue (Goserelin) every 8-weeks. This was increased to 4-weekly because of continued aggressive behaviour and detectable hormones (table 1). Capillary samples, when performed for testosterone levels, were found to be significantly higher than venous samples (table 1) raising the possibility of exogenous testosterone exposure. Detailed discussions with family members and school staff, supported by the safeguarding team, revealed no history of topical testosterone use in any contacts. Testosterone levels remained high and Anastrozole and Bicalutamide were introduced to reduce synthesis and action of testosterone. Due to parental separation, there was limited communication with the patient’s father. After a year, it was brought to our attention that dad was on transdermal testosterone therapy. Further exposure stopped as his father was changed to parenteral testosterone. Over time, Anastrozole and Bicalutamide were discontinued and his Goserelin was reduced to 10-weekly, with an improved clinical trend (table 1).

Discussion: This case highlights an unusual cause of precocious puberty due to transdermal testosterone transfer, despite clear patient information leaflets and precautionary measures. This was further complicated by the challenges in obtaining complete information due to the family situation. There is a need to reinforce information repeatedly to patients on transdermal testosterone and educate them of the symptoms that may occur in contacts during accidental transfer