Endocrine Case Study 4*


A distraught mother brings her 6-year-old boy to his pediatrician.  Since the age of two, he has had a history of rapid growth, often being the largest child amongst his peers.  For the past six month he has been showing growth of pubic hair.


Prior to the current visit, his obstetric history was unremarkable. He was a full-term infant born to a 34-year-old healthy mom by normal vaginal delivery after an uncomplicated gestation. His birth weight was normal and there were no neonatal problems. At 9 - 18 months, his growth was at the 95th percentile for his age; his height at age 2 1/2 was average for 4 1/2 years (his parents were tall). His penis appeared larger than those of his peers at 3 years, he developed some facial acne at 4 years, and pubic hair was seen at 5 1/2 years.


His height was average for 10 years and 3 months and his weight was average for 9 years and 10 months. The blood pressure was normal. He was tall, well proportioned, and muscular with mild facial acne. The penis was large for his age and there was fine pubic hair (Tanner stage II of puberty). The testes were estimated to be 3 ml volume each (small for puberty stage). A neurological exam  was normal.


General Questions

1.)  Desribe the mechanism by which a peptide hormone initiates a cell response; a steroid hormone initiates a cell response. How are they the same? How are they different? Give a specific example of each and state their effect on the human body.


2.) Compare the hormonal controls of the male reproductive cycle with the hormonal controls of the female reproductive cycle.  How are they the same?  How are they different?

Specific Questions

1.)Describe the “normal” sequence of events beginning at puberty resulting in sexual maturity?  Include age and primary and secondary effects.

2 .) What might be the primary cause of the patient’s symptoms? 

3.)  What role do gonadotropins play in your diagnosis?  Explain.

4.)  Can females be affected by similar hormonal dysfunction?  Explain.

5.)  How does this case compare to a patient with androgen insensitivity?

6.)  What treatments are appropriate for this 6-year old?  Include both physical and emotional health.


*adapted from Case Studies in Endocrine Disorders by J. Harrison, Tulane University