Males with precocious puberty will usually manifest physical features that indicate the primary diagnosis. Symmetrical testicular enlargement is the first sign of central precocious puberty in males in most cases, while irregularly enlarged testes are found in Leydig cell tumours or adrenal rests. Elevated levels of hCG secreted from a tumour will only minimally enlarge the testes but will be associated, with a positive pregnancy test. Small testes with virilisation lead to the possibility of congenital adrenal hyperplasia or an adrenal tumour.
