Congenital adrenal hyperplasia-induced central precocious puberty: Importance of early recognition and treatment
DOI:
https://doi.org/10.3329/jacedb.v5i2.87119Keywords:
Congenital adrenal hyperplasia, Precocious puberty, Gonadotropin releasing hormone agonist, Testicular microlithiasisAbstract
One of the commonest causes of peripheral precocious puberty in boys is congenital adrenal hyperplasia (CAH). Hydrocortisone treatment typically prevents peripheral precocity from progressing. However, a small number of patients may develop central precocious puberty while receiving this therapy. In this situation, gonadotropin-releasing hormone analogue (GnRHa) therapy typically arrests subsequent pubertal progression and advancement of bone age. Here, we present a boy with peripheral iso-sexual precocious puberty due to CAH presented at eight years. Since the age of six years, he had a history of the appearance of pubic hair, penile lengthening, offensive behaviour, and gradual darkening of skin. However, his pubertal development and bone age advancement persisted even after conventional treatment with hydrocortisone and fludrocortisone. Conversion to central precocious puberty was subsequently confirmed by clinical and hormonal evaluation. Further, pubertal progression was successfully arrested with a GnRHa in addition to a glucocorticoid and mineralocorticoid regimen. Delayed diagnosis and treatment of CAH may be complicated by true precocious puberty, which can be successfully arrested by treatment with GnRHa along with hydrocortisone and fludrocortisone.
[J Assoc Clin Endocrinol Diabetol Bangladesh, July 2026; 5 (2): e87119]
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References
1. Khalid JM, Oerton JM, Dezateux C, Hindmarsh PC, Kelnar CJ, Knowles RL. Incidence and clinical features of congenital adrenal hyperplasia in Great Britain. Arch Dis Child 2012;97(2):101-06. DOI: https://doi.org/10.1136/archdischild-2011-300234
2. Merke DP, Kabbani M. Congenital adrenal hyperplasia: epidemiology, management and practical drug treatment. Paediatr Drugs 2001;3(8):599-611. DOI: https://doi.org/10.2165/00128072-200103080-00005
3. Reiter EO, Kaplan SL, Conte FA, Grumbach MM. Responsivity of pituitary gonadotropes to luteinizing hormone-releasing factor in idiopathic precocious puberty, precocious thelarche, precocious adrenarche, and in patients treated with medroxyprogesterone acetate. Pediatr Res 1975;9(2):111-06. DOI: https://doi.org/10.1203/00006450-197502000-00011
4. Partsch CJ, Heger S, Sippell WG. Management and outcome of central precocious puberty. Clin Endocrinol (Oxf) 2002;56(2):129-48. DOI: https://doi.org/10.1046/j.0300-0664.2001.01490.x
5. Majumdar J, Sharan A, Mukhopadhyay S, Ghosh B, Sengupta S. Congenital adrenal hyperplasia–a rare cause of central precocious puberty—A case report. J Clin Diagn Res 2017;11(11):OD01-OD03. DOI: https://doi.org/10.7860/JCDR/2017/27330.10837
6. Speiser PW, Azziz R, Baskin LS, Ghizzoni L, Hensle TW, Merke DP, et al. A summary of the endocrine society clinical practice guidelines on congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency. Int J Pediatr Endocrinol 2010;2010:494173. DOI: https://doi.org/10.1155/2010/494173
7. Latronico AC, Brito VN, Carel JC. Causes, diagnosis, and treatment of central precocious puberty. Lancet Diabetes Endocrinol 2016;4(3):265-74. DOI: https://doi.org/10.1016/s2213-8587(15)00380-0
8. Mortimer JG, Rudd BT, Butt WR. A virilizing adrenal tumor in a prepubertal boy. J Clin Endocrinol Metab 1964;24(9):842-50. DOI: https://doi.org/10.1210/jcem-24-9-842
9. Pescovitz OH, Cassorla FE, Comite F, Loriaux DL, Cutler Jr GB. LHRH analog treatment of central precocious puberty complicating congenital adrenal hyperplasia. Ann N Y Acad Sci 1985;458:174-81. DOI: https://doi.org/10.1111/j.1749-6632.1985.tb14602.x
10. Soliman AT, AlLamki M, AlSalmi I, Asfour M. Congenital adrenal hyperplasia complicated by central precocious puberty: linear growth during infancy and treatment with gonadotropin-releasing hormone analog. Metabolism 1997;46(5):513-07. DOI: https://doi.org/10.1016/s0026-0495(97)90186-4
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Copyright (c) 2026 Md. Ashraful Hossain, Tania Tofail, Ahmad Monirul Hoque, Satya Prasad Koirala, Muhammad Abul Hasanat
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