A 7-Year-Old Boy Is Brought to the Office for Evaluation

A 7-year-old boy is brought to the office for evaluation of increasing acne and pubic hair.  Last month, his mother first noticed "a few bumps" on his nose and forehead.  Subsequently, the child developed numerous "bumps and pustules" on his face and back.  Over the past month, his mother has also noticed pubic hair growth.  The patient has no headache, vision changes, or vomiting.  He has atopic dermatitis that is controlled with corticosteroid ointment.  He takes a daily multivitamin and no other medications.  His mother experienced menarche at age 12 and his father began to shave at age 14.  The patient is in first grade, is a good student, and enjoys playing soccer.  Temperature is 36.7 C (98 F) , blood pressure is 100/60 mm Hg, and pulse is 84/min.  Cranial nerves II-XII are intact.  Visual fields have no deficits.  There is scattered comedonal and inflammatory acne across the face, chest, and shoulders.  Cardiac examination shows a regular rate and rhythm without murmur.  The abdomen is soft and nontender with no hepatosplenomegaly.  Genital examination reveals stage 2 sexual maturity rating for pubic hair.  The testes are small and without masses.  A bone age radiograph is consistent with age 9.  Which of the following is the most likely diagnosis in this patient?

A) Congenital adrenal hyperplasia
B) Idiopathic premature pubarche
C) Leydig cell tumor
D) McCune-Albright syndrome
E) Normal pubertal variant

Correct Answer:

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