Precocious Puberty Induced by Chronic Rhinosinusitis

Background: Precocious puberty is the early onset of secondary sexual characteristics before age 8 in girls and 9 in boys. It is classified into central precocious puberty (CPP), which is GnRH-dependent, and peripheral precocious puberty (PPP), which is GnRH-independent. Hypothalamic hamartomas are a well-documented cause of CPP, while chronic rhinosinusitis has not been commonly associated with early puberty. Case Presentation: We report a 6.5-year-old boy who presented with increased penile length, deepened voice, and axillary and pubic hair growth for six months. Additionally, he had a history of nasal obstruction, rhinorrhea, blurred vision, and mild headaches. Examination revealed signs of precocious puberty, including Tanner stage III pubic and axillary hair and an advanced bone age of 12 years. MRI revealed a hypothalamic hamartoma, while a CT scan showed chronic rhinosinusitis. Histopathology confirmed chronic inflammatory changes without fungal infection. The patient was initially considered for neurosurgical intervention, but after ENT evaluation, he was treated with intravenous antibiotics for chronic sinusitis. He showed clinical improvement, and surgery was no longer required. Discussion: This case highlights a rare association between chronic rhinosinusitis and CPP. While hypothalamic hamartoma is a recognized cause of early puberty, chronic inflammation might contribute to HPG axis activation. Persistent sinonasal inflammation could induce systemic inflammatory responses affecting neuroendocrine regulation. This raises questions about the potential role of chronic infections in puberty onset. Conclusion: Chronic rhinosinusitis may be an underrecognized factor influencing early puberty. Multidisciplinary evaluation, including endocrinology, neurosurgery, and ENT, is crucial in such cases to ensure accurate diagnosis and management. Further research is needed to explore the possible link between chronic inflammation and hypothalamic activation leading to precocious puberty.