MB-27: A CASE REPORT OF CENTRAL PRECOCIOUS PUBERTY IN A 7 YEARS OLD MALE WITH MEDULLOBLASTOMA PRESENTING WITH HYDROCEPHALUS

BACKGROUND: Medulloblastoma is the most common malignant brain tumor in children. The location of this tumor commonly causes fourth ventricular obstruction, resulting in hydrocephalus. Central precocious puberty (CPP) is commonly diagnosed in patients with supratentorial brain tumors and in association with hydrocephalus of various etiologies; however, there has been only one case report in the literature of CPP as the presenting symptom of medulloblastoma with hydrocephalus, which resolved after complete resection of the tumor. However it has not been reported with infratentorial tumors except in a case of medulloblastoma as well as in cases of hydrocephalus due to variable reasons. CASE REPORT: We report upon a 7 years old male with Group 4 medulloblastoma, who presented with hydrocephalus promptly alleviated by gross total tumor resection. After receiving 2 initial cycles of vincristine, cisplatin, etoposide, cyclophosphamide and methotrexate, prior to any cranial irradiation, and just 3 months from initial diagnosis, he was diagnosed with CPP, based on endocrine labs, physical exam and advanced bone age. Abnormal endocrine labs included LH level of 0.63 and total testosterone of 22. His physical exam revealed increased testicular size consistent with Tanner stage II and tall stature >3SD above normal and his bone age was advanced to 13 years. CONCLUSION: The presentation of CPP following resolution of hydrocephalus, as in our case, suggests the importance of obtaining follow up as well as baseline endocrine labs and careful physical exams in patients with posterior fossa tumors as well as supratentorial tumors presenting with hydrocephalus.