Part of “CHAPTER 92 – PRECOCIOUS AND DELAYED PUBERTY“

Contrasexual precocious puberty includes excessive virilization in girls and feminization in boys. Virilization in girls is primarily due to adrenal abnormalities and has already been discussed. Production of testosterone has also been reported in girls with ovarian juvenile granulosa cell tumors resulting in the development of pubic hair and clitoromegaly in the presence or absence of breast development and menstrual bleeding.72 Feminization in boys presents primarily as gynecomastia. Some breast tissue develops in 50% to 100% of normal boys during early puberty, with a peak occurrence at age 13 years.73 The tissue is firm and glandular in texture and may be quite tender. Gynecomastia develops as the result of an imbalance between estrogen and androgen levels. Spontaneous resolution is usually seen within 1 year, but breast tissue may persist into adulthood. Gynecomastia before the onset of puberty is always pathologic. Sertoli cell tumors associated with Peutz-Jeghers syndrome may cause gynecomastia due to increased tumor aromatase expression.74 Additionally, any gonadal or adrenal tumor may produce estrogens or have significant aromatase expression that results in varying degrees of feminization. Other causes of gynecomastia in boys include marijuana or anabolic steroid use, hypogonadism, hCG-secreting tumors,73 and the genetic aromatase excess syndrome.75