[Precocious puberty caused by a testicular Leydig cell tumor]

Area of Science:

• Pediatric Oncology
• Endocrinology

Background:

• Testicular tumors are rare in pediatric patients, with Leydig cell tumors accounting for approximately 1.5% of cases.
• Leydig cell tumors in prepubertal children are typically benign but can present with significant hormonal disturbances.

Observation:

• A 4.5-year-old boy presented with precocious puberty secondary to a Leydig cell tumor of the left testis.
• The tumor was associated with elevated sex steroid production, leading to early pubertal development.

Findings:

• Diagnostic challenges were encountered in this rare case.
• Testis-sparing surgical removal was successfully performed.
• Plasma 17-hydroxyprogesterone levels were key in distinguishing Leydig cell tumor from congenital adrenal hyperplasia in this patient.

Implications:

• This case highlights the importance of considering Leydig cell tumors in the differential diagnosis of precocious puberty in boys.
• Accurate hormonal assessment, particularly 17-hydroxyprogesterone levels, is vital for correct diagnosis.
• Minimally invasive, testis-sparing approaches are feasible and desirable for benign pediatric testicular tumors.