Effectiveness of anastrozole and cyproterone acetate in two brothers with familial male precocious puberty.
Testotoxicosis is a rare form of precocious puberty caused by a constitutively activating mutation in the luteinizing hormone receptor (LHR) gene. Symptoms include rapid virilization, accelerated growth and reduced adult height. We describe a rare association of testotoxicosis with a metaphyseal chondrodysplasia called cartilage-hair hypoplasia (CHH) and report two brothers with testotoxicosis after 4 years of treatment. The brothers had a T577I mutation in the LHR gene. One brother also presented CHH. The older brother was treated with ketoconazole, then with the aromatase inhibitor anastrozole and the anti-androgen cyproterone acetate. The younger brother received this combination as first-line therapy. Clinical improvements included reductions in growth velocity and bone maturation rate, which should result in taller adult stature. Tolerance was good.


CONCLUSIONS
Combined treatment with anastrozole and cyproterone acetate is effective in improving the prognosis of adult height in testotoxicosis.
Eyssette-Guerreau
Stéphanie
S
Paediatric Endocrinology Unit, Hôpital Necker-Enfants Malades, Paris, France.
Pinto
Graziella
G
Sultan
Ariane
A
Le Merrer
Martine
M
Sultan
Charles
C
Polak
Michel
M
D000077384:Anastrozole; D000726:Androgen Antagonists / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001827:Body Height / Q000187:drug effects; D002675:Child, Preschool; D017373:Cyproterone Acetate / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D009154:Mutation; D009570:Nitriles / Q000627:therapeutic use*; D011629:Puberty, Precocious / Q000188:drug therapy* / Q000235:genetics / Q000503:physiopathology; D011974:Receptors, LH / Q000235:genetics; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*
D000726:Androgen Antagonists; D047072:Aromatase Inhibitors; D009570:Nitriles; D011974:Receptors, LH; D014230:Triazoles; D000077384:Anastrozole; D017373:Cyproterone Acetate