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Development of central precocious puberty following cannabinoid use for paediatric epilepsy: causal or coincidence?
  1. Aditya Krishnan1,
  2. Juliana Chizo Agwu2,
  3. Chetana Kallappa2 and
  4. Rajesh Pandey2
  1. 1 University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  2. 2 Department of Paediatrics, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, Birmingham, UK
  1. Correspondence to Dr Aditya Krishnan; adityakrishnan{at}


Research suggests a role for cannabidiol oil in managing certain forms of paediatric onset epilepsy. However, studies on the impact of cannabis on the hypothalamo-pituitary-gonadal (HPG) axis have conflicting results. Delta-9-tetrahydrocannabinol (Δ9-THC) acutely inhibits gonadotropin-releasing hormone in the hypothalamus, reducing testosterone levels by 65% in rhesus monkeys. Additionally, there have been reports of pubertal arrest and delayed puberty in male cannabis users. In contrast, other studies have reported higher testosterone levels following long-term cannabis use.

A 2-year-old boy presented with testicular enlargement, increased penile length and growth of coarse pubic hair developing over 6 months. His mother procured cannabidiol oil online, which he started taking 7 months earlier for severe epilepsy refractory to medical management. Subsequent investigations confirmed central precocious puberty. While it is unclear whether the precocious puberty is a direct consequence of HPG axis activation by Δ9-THC, this case demonstrates a temporal association between cannabis use and development of precocious puberty.

  • developmental paediatrocs
  • epilepsy and seizures
  • neuroendocrinology
  • endocrinology

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  • Contributors AK undertook the literature review and prepared the manuscript. JCA was involved with patient care and critical review of the manuscript. CK and RP were involved with patient care and revised the manuscript. All authors approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.