Rare Presentation of Precocious Puberty Secondary to LH-Secreting Adenoma

An 8-year 9-month-old male presented with signs of precocious puberty, including facial hair, phallic growth, body odor, and acne, which is unusual for his age. Laboratory tests showed elevated levels of luteinizing hormone (LH) and testosterone, but pre-pubertal levels of follicle-stimulating hormone (FSH) and only mildly elevated androgens. An MRI revealed an anterior pituitary adenoma. Despite not responding to leuprolide, a medication typically used to treat precocious puberty, the patient's pubertal progression was minimized with spironolactone and anastrozole before he underwent a transsphenoidal adenomectomy. Post-surgery, his LH and testosterone levels decreased to within normal ranges. This case highlights the importance of LH and FSH in pubertal development and suggests that atypical pubertal development should prompt consideration of rare pathologies like functioning gonadotroph adenomas, which are less than 1% hormonally active and often require surgical intervention due to the limited success of medical therapies.