REPORT OF A CASE OF CENTRAL PRECOCIOUS PUBERTY IN A BOY ASSOCIATED WITH PILOCYTIC ASTROCYTOMA

Abstract

Introduction. Central precocious puberty (CPP) refers to premature activation of the hypothalamic–pituitary–gonadal (HPG) axis, resulting in early development of secondary sexual characteristics before the age of 8 in girls and 9 in boys.In patients with CPP, MRI images reveal the following types of tumors: astrocytomas, optic nerve gliomas, craniopharyngiomas, hypothalamic tumors and tumors of the pons, suprasellar tumors, fourth ventricle tumors, pineal tumors, neuroblastoma, germ-cell tumors, retinoblastoma, pituitary macroadenoma, Ewing’s sarcoma, Burkitt’s lymphoma and Langerhans cell histiocytosis. Case presentation. In this report, we present the case of a boy with pilocytic astrocytoma, who was operated on at the age of 2, and whose sexual development began at the age of 4 years 6 months. Currently, the patient has been taking triptorelin acetate 3,75mg/every 4 weeks continuously for 1,5 years without signs of secondary sexual characters progression. Discussion and conclusion. In our reported case, as the malignancy of pilocytic astrocytoma and metastasis to the spinal cord was observed, the patient underwent partial removal of the tumor in the chiasmal-sellar area and a series of chemotherapy procedures. 3,5 years after the diagnosis of the chiasmal-sellar region tumor, when the boy was 4,5 years old, signs of sexual development appeared. Taking into account symmetrical enlargement of testicles, high levels of unstimulated and stimulated LH, advancement of the bone age for 4 years, exclusion of other forms of precocious puberty, the patient diagnosed with CPP.  In addition, the patient is under the supervision of a pediatric oncologist, no clinical and radiological signs of tumor growth have been detected in the boy for 6 months follow up.