Clinical Brief 102 Precocious Pseudopuberty With Testicular Enlargement R. Rajput, A. Bhansali, R. Bhat and R. Sialy Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India Abstract. Gonadotropins independent precocious puberty (GIPP) in male is characterized by early appearance of sexual hairs and phallic growth but without testicular enlargement. We report a case of GIPP with testicular enlargement who was diagnosed to have testotoxicosis and successfully managed with spironolactone. [Indian J Pediatr 2006; 73 (4) : 356-358] E-mai/ : ani/bhansa/i_endocrine@rediffrnai/.corn Key words : Precocious pseudopuberty; Testotoxicosis Puberty is the process of physical maturation manifested by an increase in growth rate and appearance of secondary sexual characteristics. Puberty is said to be precocious if it occurs in boys younger than 9 years of age, while in girls, less than 7 years of age, and in African American girls younger than 6 years of age? Precocious puberty can be divided into two categories. The first category is gonadotropins dependent precocious puberty (GDPP) or true precocious puberty, which involves the premature activation of hypothalamic-pituitary-gonadal axis and characterized by appearance of axillary and pubic hairs along with testicular enlargement. The second category is gonadotropins independent precocious puberty (GIPP) or precocious pseudopuberty in which the increase in sex steroids is independent of pituitary gonadotropins release, and axillary and pubic hairs appear along with phallic enlargement but without associated testicular enlargement2, 2 We describe a case of a five and a half year old boy who presented with precocious pseudopuberty with testicular enlargement. CASE REPORT radiation and exposure to exogenous sex steroids. On examination, his height was 128 cm (90 th percentile) and weight was 23.4 kg, with target height of 165.3cm. He had no cafd-au-lait spots and bony swellings. Systemic examination was unremarkable. Genital ex~mination revealed a stretched penile length (SPL) of 6 cm and testicular volume of 6 ml bilaterally (Prader's orchido- meter). Both testes were firm, symmetrical and non- tender (Fig 1). Axillary and pubic hairs were Tanner stage 2 and had no gynecomastia. Investigations revealed a A five and a half-year-old boy presented with progressive phallic enlargement, development of axillary and pubic hairs, aggressive behavior and rapid increase in height over the last two years. The child was born of a non- consanguineous marriage and had no family history of precocious puberty. He had no history of central nervous system infections, head injury, neoplasm or prior Correspondence and Reprint requests : Dr. Anil Bhansali, Department of Endocrinology, Postgraduate Institute of Medical, Education and Research, Chandigarh- 160012, India. Fax : 91-172- 744401, 745078 356 Fig. 1. Showing clinical profile of the patient. Indian Journal of Pediatrics, Volume 73--April, 2006