Question

Discuss the following in a 3-year-old male child with sexual precocity:
Differential diagnosis

Hint:

A thorough workup, including hormone assays and imaging, is crucial in differentiating between central and peripheral precocious puberty.

Answer 1

Step 1: Definition of Sexual Precocity:
Sexual precocity refers to the early onset of secondary sexual characteristics in a child. In a 3-year-old male, this could involve the development of early signs of puberty, such as testicular enlargement, pubic hair growth, and increased levels of testosterone.

Step 2: Differential Diagnosis:
1. Central Precocious Puberty (CPP): This is caused by the early activation of the hypothalamic-pituitary-gonadal axis. It is typically idiopathic but can be caused by CNS tumors, infections, or trauma.
2. Peripheral Precocious Puberty: This occurs due to excess gonadal or adrenal steroid production, independent of the hypothalamic-pituitary-gonadal axis. Causes include:
- Congenital Adrenal Hyperplasia (CAH): CAH can lead to excess androgen production and early virilization.
- Gonadal Tumors: Tumors in the testes or ovaries can produce excess sex hormones.
3. Exogenous Hormone Exposure: Accidental or deliberate exposure to external sources of androgens, such as medications or creams, may cause precocious puberty.