Testotoxicosis: Report of Two Cases, One with a Novel Mutation in LHCGR Gene

J Clin Res Pediatr Endocrinol. 2015 Sep;7(3):242-8. doi: 10.4274/jcrpe.2067.

Abstract

Testotoxicosis is a rare disorder which presents as isosexual peripheral precocious puberty in males. Despite the pattern of autosomal dominant inheritance, sporadic cases also may occur. Due to activating mutation in luteinizing hormone (LH))/choriogonadotropin receptor (LHCGR) gene, early virilization and advancement in bone age are common with increased serum testosterone levels above adult ranges, despite low LH and follicular-stimulating hormone (FSH) levels. There are different treatment regimens, such as combination of bicalutamide (antiandrogen agent) and a third-generation aromatase inhibitor, that are reported to be well-tolerated and successful in slowing bone age advancement and preventing progression of virilization. We report here two patients who presented with peripheral precocious puberty and an activating mutation in the LHCGR gene: one with a family history and previously determined mutation and the other without family history and with a novel mutation (c.830G>T). Combination of bicalutamide+anastrozole was ineffective in slowing pubertal progression and bone age. Short-term results were better with ketoconazole.

Publication types

  • Case Reports

MeSH terms

  • Anastrozole
  • Androgen Antagonists / therapeutic use
  • Anilides / therapeutic use
  • Aromatase Inhibitors / therapeutic use
  • Cytochrome P-450 CYP3A Inhibitors / therapeutic use
  • Genetic Predisposition to Disease / genetics*
  • Humans
  • Infant
  • Ketoconazole / therapeutic use
  • Male
  • Mutation*
  • Nitriles / therapeutic use
  • Puberty, Precocious / diagnosis
  • Puberty, Precocious / drug therapy
  • Puberty, Precocious / genetics*
  • Receptors, LH / genetics*
  • Sequence Analysis, DNA / methods
  • Testosterone / blood
  • Tosyl Compounds / therapeutic use
  • Triazoles / therapeutic use

Substances

  • Androgen Antagonists
  • Anilides
  • Aromatase Inhibitors
  • Cytochrome P-450 CYP3A Inhibitors
  • Nitriles
  • Receptors, LH
  • Tosyl Compounds
  • Triazoles
  • Anastrozole
  • Testosterone
  • bicalutamide
  • Ketoconazole

Supplementary concepts

  • Familial Testotoxicosis