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Luteinizing hormone‐releasing hormone analog treatment for a criminal sexual habit caused by male precocious puberty

Tanaka et al . investigated psychosocial factors responsible for increasing psychosomatic symptoms with age in elementary schoolchildren. 1 They reported that a stronger relationship between physical complaints and psychosocial problems was found in the older than in the younger age group. 1 Through one of our patients, it is suggested that sexual development has an influence on the increase of psychosocial problems with age during elementary school. We recently treated a 10year-old boy who presented with an abnormal sexual habit caused by idiopathic central precocious puberty. At 9 years of age, the patient started habitual stealing and collection of underwear of women in their twenties, leading him to the level of criminal conduct. He was then noticed to have pubic hair and an adult voice. At 10 years of age, when he was referred to us for a consultation regarding this conduct, he was 166.5 cm tall (+3.0 standard deviation) and his testicular volume was 25 mL (normal, 4 mL). His bone age was far advanced at 13.5 years (+35%). Serum testosterone was increased to the pubertal level, 117.0 ng/dL, and a luteinizing hormone-releasing hormone (LH-RH) test induced pubertal gonadotropin responses (basal LH, 0.7 mIU/mL, and peak LH, 12.1 mIU/mL; basal follicular stimulating hormone (FSH), 4.0 mIU/mL, and peak FSH, 6.0 mIU/mL), suggesting that he had central precocious puberty. The patient did not present any neurodevelopmental abnormality or any abnormal magnetic resonance image of the brain. Although precocious puberty was not expected to cause poor growth prognosis, we started an LH-RH analog (Leuprolide, Takeda, Tokyo, Japan), 30 μ g/kg for 4 weeks, as therapy for his abnormal sexual habit. The therapy decreased the level of serum testosterone and the gonadotropin response on LH-RH test, and the habit of stealing women’s underwear disappeared 6 months after the beginning of therapy. Psychosocial problems occur in central precocious puberty both because pubertal levels of sex steroids in young children result in disruptive behavior and because the child looks so much older than his or her true age. 2 The decision to treat should be based on the assessment of growth prognosis and of the child’s psychological maturity.