{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T04:21:32Z","timestamp":1777350092646,"version":"3.51.4"},"reference-count":17,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,2,27]]},"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:p>Precocious puberty, characterised by the early appearance of secondary sexual characteristics, poses challenges in diagnosis and management. Here, we describe a case of precocious puberty diagnosed in a boy in middle childhood, who presented with progressive phallus enlargement, pubic hair development and increased aggressive behaviour. Hormonal evaluation confirmed the diagnosis of congenital adrenal hyperplasia (CAH), complicated by gonadotropin-dependent precocious puberty. The case highlights the importance of assessment of testicular volume in a patient presenting with precocious puberty. Symmetrical testicular enlargement in a patient with CAH suggests premature activation of the hypothalamic\u2013pituitary\u2013gonadal axis. The patient received glucocorticoid therapy to suppress androgen production related to CAH and gonadotropin-releasing hormone analogue therapy to control premature activation of the hypothalamic\u2013pituitary\u2013gonadal axis. Follow-up visits showed regression of secondary sexual characteristics and improved growth velocity.<\/jats:p>","DOI":"10.1136\/bcr-2023-257579","type":"journal-article","created":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T00:00:57Z","timestamp":1709596857000},"page":"e257579","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Congenital adrenal hyperplasia complicated by gonadotropin-dependent precocious puberty"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7533-8726","authenticated-orcid":false,"given":"Ahmad","family":"Alam","sequence":"first","affiliation":[{"name":"Rajiv Gandhi Centre for Diabetes and Endocrinology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neeraj Kumar","family":"Agrawal","sequence":"additional","affiliation":[{"name":"Endocrinology and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Surya K","family":"Singh","sequence":"additional","affiliation":[{"name":"Endocrinology and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,3,4]]},"reference":[{"key":"2025082712015173000_17.3.e257579.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp0800459"},{"key":"2025082712015173000_17.3.e257579.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecl.2015.02.002"},{"key":"2025082712015173000_17.3.e257579.3","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4103\/ijem.IJEM_242_18","article-title":"Stretched penile length and testicular size from birth to 18 years in boys from Western Maharashtra","volume":"23","author":"Jaiswal","year":"2019","journal-title":"Indian J Endocrinol Metab"},{"key":"2025082712015173000_17.3.e257579.4","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1038\/s41574-022-00655-w","article-title":"Management challenges and therapeutic advances in congenital adrenal hyperplasia","volume":"18","author":"Mallappa","year":"2022","journal-title":"Nat Rev Endocrinol"},{"key":"2025082712015173000_17.3.e257579.5","doi-asserted-by":"crossref","unstructured":"Bhansali A , Aggarwal A , Parthan G , et al . Congenital adrenal hyperplasia. In: Clinical rounds in endocrinology, 2. 2016: 335\u201376.","DOI":"10.1007\/978-81-322-2815-8_10"},{"key":"2025082712015173000_17.3.e257579.6","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2009-2616"},{"key":"2025082712015173000_17.3.e257579.7","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1056\/NEJMra1909786","article-title":"Congenital adrenal hyperplasia due to 21-hydroxylase deficiency","volume":"383","author":"Merke","year":"2020","journal-title":"N Engl J Med"},{"key":"2025082712015173000_17.3.e257579.8","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-19-7-844"},{"key":"2025082712015173000_17.3.e257579.9","doi-asserted-by":"crossref","DOI":"10.1186\/1750-1172-3-12","article-title":"Mccune-albright syndrome","volume":"3","author":"Dumitrescu","year":"2008","journal-title":"Orphanet J Rare Dis"},{"key":"2025082712015173000_17.3.e257579.10","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s42000-018-0029-1","article-title":"Central precocious puberty in a case of late-diagnosed familial testotoxicosis and long-term treatment monitoring","volume":"17","author":"Kor","year":"2018","journal-title":"Hormones (Athens)"},{"key":"2025082712015173000_17.3.e257579.11","article-title":"Leydig cell tumor-induced gonadotropin-independent precocious puberty progressing to gonadotropin-dependent precocious puberty post orchiectomy: out of the frying pan into the fire","volume":"14","author":"Singhania","year":"2022","journal-title":"Cureus"},{"key":"2025082712015173000_17.3.e257579.12","doi-asserted-by":"crossref","unstructured":"Bhansali A , Aggarwal A , Parthan G , et al . Precocious puberty. In: Clinical rounds in endocrinology, 2. 2016: 71\u2013210.","DOI":"10.1007\/978-81-322-2815-8_6"},{"key":"2025082712015173000_17.3.e257579.13","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-58-5-857"},{"key":"2025082712015173000_17.3.e257579.14","doi-asserted-by":"crossref","first-page":"265","DOI":"10.14310\/horm.2002.1555","article-title":"Gonadotropin-releasing hormone analog treatment in children with congenital adrenal hyperplasia complicated by central precocious puberty","volume":"14","author":"G\u00fcven","year":"2015","journal-title":"Hormones (Athens)"},{"key":"2025082712015173000_17.3.e257579.15","doi-asserted-by":"crossref","first-page":"858","DOI":"10.4103\/ijem.IJEM_254_18","article-title":"Central precocious puberty complicating congenital adrenal hyperplasia: North Indian experience","volume":"22","author":"Dayal","year":"2018","journal-title":"Indian J Endocrinol Metab"},{"key":"2025082712015173000_17.3.e257579.16","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-1024"},{"key":"2025082712015173000_17.3.e257579.17","first-page":"577","article-title":"Precocious pseudo-puberty with Testicular enlargement: two cases of Leydig cell tumor with different histopathological results","volume":"12","author":"Wahyudi","year":"2020","journal-title":"Res Rep Urol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-257579","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:02:02Z","timestamp":1756321322000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-257579"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3]]},"references-count":17,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,3,4]]},"published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1136\/bcr-2023-257579"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-257579","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3]]}}}