Case 976-- Undetectable Luteinizing Hormone Levels in a Precocious Puberty Evaluation

Eric D. Carlsen, MD, PhD; Octavia Peck Palmer, PhD


A 6 year-old male presented with early pubarche and was evaluated for premature puberty. Skeletal evaluation at that time revealed a bone age of 9 years. The results of a leuprolide challenge test are shown in the top portion of Table 1. Shortly thereafter, the patient was lost to follow-up. At age 10, the patient returned to clinical attention after a pediatrician found he was Tanner stage III and repeat skeletal evaluation suggested a bone age of 14 years. The results of a second leuprolide challenge test are shown in the bottom portion of Table 1.


The patient's baseline serum sample was rerun on a Meso SECTOR Imager, yielding a luteinizing hormone level of 5.8 mIU/mL (above the age-adjusted range). Subsequent imaging failed to identify lesions in the pituitary, testes, or adrenal glands.


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