C. Kitanaka et al., PRECOCIOUS PUBERTY IN A GIRL WITH AN HCG-SECRETING SUPRASELLAR IMMATURE TERATOMA, Journal of neurosurgery, 81(4), 1994, pp. 601-604
Although precocious puberty is common in boys with human chorionic gon
adotropin (hCG)-secreting brain tumors, it is extremely rare in girls.
The authors describe a 6-year-old girl with an hCG-secreting suprasel
lar immature teratoma who presented with diabetes insipidus, increased
intracranial pressure, and precocious puberty, On admission, breast b
udding was observed. The serum hCG level was 1230 mIU/ml. Both luteini
zing hormone (LH) and follicle-stimulating hormone (FSH) remained belo
w detectable levels, even after gonadotropin-releasing hormone stimula
tion. Serum estrogen and androgen were moderately elevated. After chem
otherapy, breast budding disappeared with normalization of serum hCG.
It has been believed that hCG does not produce precocious puberty in g
irls in the absence of FSH, and this has been used as an explanation f
or the rarity of precocious puberty in girls with hCG-secreting brain
tumors. However, it has also been reported that hCG has not only LH ac
tivity but also intrinsic, although weak, FSH-like activity. In the pr
esent case, this FSH-like activity was considered to have played a rol
e in the development of precocious puberty. It is speculated that a ve
ry high level of serum hCG can produce precocious puberty in girls. Th
e rarity of intracranial germ-cell tumors with a high potential of hCG
secretion may be one of the reasons why hCG-induced precocious pubert
y is uncommon in girls.