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Male patients presenting with rapidly progressive puberty associated with malignant tumors.

Kim SJ, Ko AR, Jung MK, Kim KE, Chae HW, Kim DH, Kim HS, Kwon AR - Ann Pediatr Endocrinol Metab (2016)

Bottom Line: PP is usually idiopathic; though, organic abnormalities including tumors are more frequently found in male patients with PP.Histopathologic analysis confirmed a yolk-sac tumor.Therefore, in male patients with accelerated or advanced puberty, malignancy should be considered, with evaluation of tumor markers.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
In males, precocious puberty (PP) is defined as the development of secondary sexual characteristics before age 9 years. PP is usually idiopathic; though, organic abnormalities including tumors are more frequently found in male patients with PP. However, advanced puberty in male also can be an important clinical manifestation in tumors. We report 2 cases of rapidly progressive puberty in males, each associated with a germ-cell tumor. First, an 11-year-old boy presented with mild fever and weight loss for 1 month. Physical examination revealed a pubertal stage of G3P3 with 10-mL testes. Investigations revealed advanced bone age (16 years) with elevated basal luteinizing hormone and testosterone levels. An anterior mediastinal tumor was identified by chest radiography and computed tomography, and elevated α-fetoprotein (AFP) and β-human chorionic gonadotropin (β-hCG) levels were noted. Histopathologic analysis confirmed a yolk-sac tumor. Second, a 12-year-old boy presented with diplopia, polydipsia, and polyuria for 4 months. Physical examination revealed a pubertal stage of G3P3 with 8-mL testes. Bone age was advanced (16 years) and laboratory tests indicated panhypopituitarism with elevated testosterone level. A mixed germ-cell tumor was diagnosed with elevated AFP and β-hCG levels. Of course, these patients also have other symptoms of suspecting tumors, however, rapidly progressive puberty can be the more earlier screening sign of tumors. Therefore, in male patients with accelerated or advanced puberty, malignancy should be considered, with evaluation of tumor markers. In addition, advanced puberty in male should be recognized more widely as a unique sign of neoplasm.

No MeSH data available.


Related in: MedlinePlus

(A) Chest radiograph showing multiple lung and pleural nodules and masses with right pleural effusion. (B) Left hand bone age radiograph at diagnosis. The arrow indicates lung and pleural nodules and masses.
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Figure 1: (A) Chest radiograph showing multiple lung and pleural nodules and masses with right pleural effusion. (B) Left hand bone age radiograph at diagnosis. The arrow indicates lung and pleural nodules and masses.

Mentions: A basal thyroid-function test was conducted for differential diagnosis of hyperthyroidism and chest radiography was performed because of the cough and mild fever. In addition, because of the patient's advanced Tanner pubertal stage, hormonal studies were also performed. Thyroid function was found to be normal (T3, 0.52 ng/mL; normal range, 0.58–1.59 ng/mL; free T4, 1.28 ng/dL; normal range, 0.70–1.48 ng/dL; and thyroid-stimulating hormone, 0.95 µIU/mL; normal range, 0.35–4.49 µIU/mL) and thyroid-stimulating antibody was also negative. The patient's luteinizing hormone (LH) level was appropriate for his age, but testosterone was elevated compared to normal values for the patient's age and sex (LH, 0.61 mIU/mL; normal range, 0.2–5.0 mIU/mL; testosterone, 509.8 ng/dL; normal range, 100–320 ng/dL). His bone age was advanced, estimated to be 16 years and to sum it up the results, he was just suspected rapidly progressive or advanced puberty. However, the initial chest radiography revealed multiple lung and pleural nodules and masses with right pleural effusion (Fig. 1). A chest computed tomography scan was performed and revealed an anterior mediastinal mass (5.4 cm×4.5 cm×6.0 cm) with lymph node, lung, and pleural metastases, suggesting a malignant germ-cell tumor (GCT). Levels of tumor biomarkers were elevated, including α-fetoprotein (AFP), 20,509.21 ng/mL (normal range, 0.6–3.9 ng/mL) and β-human chorionic gonadotropin (β-hCG), 60 mIU/mL (normal range, <25 mIU/mL). Histopathologic examination of the mass by gun biopsy indicated a yolk-sac tumor.


Male patients presenting with rapidly progressive puberty associated with malignant tumors.

Kim SJ, Ko AR, Jung MK, Kim KE, Chae HW, Kim DH, Kim HS, Kwon AR - Ann Pediatr Endocrinol Metab (2016)

(A) Chest radiograph showing multiple lung and pleural nodules and masses with right pleural effusion. (B) Left hand bone age radiograph at diagnosis. The arrow indicates lung and pleural nodules and masses.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835563&req=5

Figure 1: (A) Chest radiograph showing multiple lung and pleural nodules and masses with right pleural effusion. (B) Left hand bone age radiograph at diagnosis. The arrow indicates lung and pleural nodules and masses.
Mentions: A basal thyroid-function test was conducted for differential diagnosis of hyperthyroidism and chest radiography was performed because of the cough and mild fever. In addition, because of the patient's advanced Tanner pubertal stage, hormonal studies were also performed. Thyroid function was found to be normal (T3, 0.52 ng/mL; normal range, 0.58–1.59 ng/mL; free T4, 1.28 ng/dL; normal range, 0.70–1.48 ng/dL; and thyroid-stimulating hormone, 0.95 µIU/mL; normal range, 0.35–4.49 µIU/mL) and thyroid-stimulating antibody was also negative. The patient's luteinizing hormone (LH) level was appropriate for his age, but testosterone was elevated compared to normal values for the patient's age and sex (LH, 0.61 mIU/mL; normal range, 0.2–5.0 mIU/mL; testosterone, 509.8 ng/dL; normal range, 100–320 ng/dL). His bone age was advanced, estimated to be 16 years and to sum it up the results, he was just suspected rapidly progressive or advanced puberty. However, the initial chest radiography revealed multiple lung and pleural nodules and masses with right pleural effusion (Fig. 1). A chest computed tomography scan was performed and revealed an anterior mediastinal mass (5.4 cm×4.5 cm×6.0 cm) with lymph node, lung, and pleural metastases, suggesting a malignant germ-cell tumor (GCT). Levels of tumor biomarkers were elevated, including α-fetoprotein (AFP), 20,509.21 ng/mL (normal range, 0.6–3.9 ng/mL) and β-human chorionic gonadotropin (β-hCG), 60 mIU/mL (normal range, <25 mIU/mL). Histopathologic examination of the mass by gun biopsy indicated a yolk-sac tumor.

Bottom Line: PP is usually idiopathic; though, organic abnormalities including tumors are more frequently found in male patients with PP.Histopathologic analysis confirmed a yolk-sac tumor.Therefore, in male patients with accelerated or advanced puberty, malignancy should be considered, with evaluation of tumor markers.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
In males, precocious puberty (PP) is defined as the development of secondary sexual characteristics before age 9 years. PP is usually idiopathic; though, organic abnormalities including tumors are more frequently found in male patients with PP. However, advanced puberty in male also can be an important clinical manifestation in tumors. We report 2 cases of rapidly progressive puberty in males, each associated with a germ-cell tumor. First, an 11-year-old boy presented with mild fever and weight loss for 1 month. Physical examination revealed a pubertal stage of G3P3 with 10-mL testes. Investigations revealed advanced bone age (16 years) with elevated basal luteinizing hormone and testosterone levels. An anterior mediastinal tumor was identified by chest radiography and computed tomography, and elevated α-fetoprotein (AFP) and β-human chorionic gonadotropin (β-hCG) levels were noted. Histopathologic analysis confirmed a yolk-sac tumor. Second, a 12-year-old boy presented with diplopia, polydipsia, and polyuria for 4 months. Physical examination revealed a pubertal stage of G3P3 with 8-mL testes. Bone age was advanced (16 years) and laboratory tests indicated panhypopituitarism with elevated testosterone level. A mixed germ-cell tumor was diagnosed with elevated AFP and β-hCG levels. Of course, these patients also have other symptoms of suspecting tumors, however, rapidly progressive puberty can be the more earlier screening sign of tumors. Therefore, in male patients with accelerated or advanced puberty, malignancy should be considered, with evaluation of tumor markers. In addition, advanced puberty in male should be recognized more widely as a unique sign of neoplasm.

No MeSH data available.


Related in: MedlinePlus