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Pediatric solid tumors have a range of clinical presentations, including those driven by the ectopic production of hormones secreted by some malignancies. Functional tumors lead to a variety of presentations, including Cushing syndrome, growth acceleration, abnormal virilization or feminization, and hypertension with electrolyte abnormalities. Precocious puberty, the onset of secondary sexual characteristics before age 8 in girls or 9 in boys, may be a warning sign of occult malignancy. Early referral is critical to optimize survival and limit disease- and treatment-related morbidities. Diagnostic workup and treatment should be guided by an interdisciplinary specialist team. Some tumors are associated with inherited cancer predisposition syndromes, which may have implications for surveillance and screening of family members. We describe a series of patients with rare functional tumors who presented with peripheral precocity to our tertiary referral centre at BC Children's Hospital to highlight key concepts for physicians: recognize, refer early, and review recommendations for genetic screening. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Puberty onset and development contribute substantially to adolescents' bone mass and body composition. Our objective with this study was to examine the effects of gonadotropin-releasing hormone agonists (GnRHa) on these puberty-induced changes among youth with gender dysphoria (GD). METHODS: Medical records of the endocrine diversity clinic in an academic children's hospital were reviewed for youth with GD seen from January 2006 to April 2017 with at least 1 baseline dual-energy radiograph absorptiometry measurement. RESULTS: At baseline, transgender females had lower lumbar spine (LS) and left total hip (LTH) areal bone mineral density (aBMD) and LS bone mineral apparent density (BMAD) z scores. Only 44.7% of transgender youth were vitamin D sufficient. Baseline vitamin D status was associated with LS, LTH aBMD, and LS BMAD z scores. Post-GnRHa assessments revealed a significant drop in LS and LTH aBMD z scores (transgender males and transgender females) without fractures and LS BMAD (transgender males), an increase in gynoid (fat percentage), and android (fat percentage) (transgender males and transgender females), and no changes in BMI z score. CONCLUSIONS: GnRHa monotherapy negatively affected bone mineral density of youth with GD without evidence of fractures or changes in BMI z score. Transgender youth body fat redistribution (android versus gynoid) were in keeping with their affirmed gender. The majority of transgender youth had vitamin D insufficiency or deficiency with baseline status associated with bone mineral density. Vitamin D supplementation should be considered for all youth with GD. [ABSTRACT FROM AUTHOR]