Abstract
Background: Whether girls with central precocious puberty (CPP) should undergo routine brain magnetic resonance imaging (MRI) to identify potential intracranial pathologies is controversial.Aims: To evaluate the brain MRI results of girls with CPP and identify the clinical and endocrine predictors of brain abnormalities.Methods: This retrospective study obtained data from pediatric endocrine clinics at Chang Gung Children's Hospital. From 1997 and 2017, 403 girls were consecutively diagnosed with CPP. After the exclusion of patients with a history of central nervous system (CNS) insults or associated neuropsychiatric symptom or signs, we studied the prevalence of brain abnormalities in 251 girls with CPP who received detailed MRI examinations of the hypothalamus and pituitary area. We also recorded the demographic data of the participants, including the onset of puberty; initial pubertal status; height; weight; uterus and ovary sizes; and basal luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol levels, and the response to GnRH stimulation test.Results: Among the 251 girls with CPP, we observed no brain alterations in 190 (75.70%), abnormalities in the hypothalamic-pituitary (H-P) area in 54 (21.51%), and abnormalities in the non-H-P area in 7 (2.79%). Among the 54 patients that had H-P lesions, we noted pathological findings related to CPP (hypothalamic hamartoma) in only one (0.4%) girl aged below 6 years old. We also identified incidental findings in the other girls with H-P lesions, including non-functioning pituitary microadenomas (12.35%), pituitary pars intermedia cysts (4.38%), Rathke's pouch cysts (1.99%), pituitary hypoplasia (1.59%), and pineal gland cysts (0.8%). The patients that had non-H-P lesions were found to have arachnoid cysts (1.59%), Chiari I malformation (0.4%), prepontine nodule (0.4%), and choroidal fissure cyst (0.4%). Of all the patients with brain lesions, 45 (73.77%) underwent regular MRI follow-up. While none of the H-P and non-H-P lesions showed progression, 19.67% of these regressed during the follow-up. None of the participants exhibited other hormonal abnormalities or underwent surgery.Conclusion: The prevalence of true pathological brain lesions related to CPP in girls without prior symptoms or signs of CNS lesions was low (0.4%). None of the girls with intracranial lesions required further intervention besides the GnRH agonist treatment. These data question the routine use of brain MRI in all girls with CPP, especially in those who are healthy without neurologic symptoms.
Highlights
Central precocious puberty (CPP), which affects 1 in 5,000– 10,000 girls, is caused by the premature activation of the hypothalamic-pituitary-gonadal axis [1, 2]
This study evaluated the prevalence and type of intracranial findings in girls with CPP with no previous central nervous system (CNS) lesions, or related symptom and signs, and examined the necessity of routine brain magnetic resonance imaging (MRI) in girls with CPP
A total of 403 girls were diagnosed as having CPP, of which 29 had previous brain insults, peripheral precocious puberty (PPP; e.g., congenital adrenal hyperplasia, McCune Albright syndrome, functional ovarian cysts, ovarian teratoma) with secondary CPP, syndromic precocious puberty, and neuropsychiatric symptoms (Figure 1)
Summary
Central precocious puberty (CPP), which affects 1 in 5,000– 10,000 girls, is caused by the premature activation of the hypothalamic-pituitary-gonadal axis [1, 2]. Girls with CPP typically experience the onset of secondary sexual characteristics before the age of 8 years [1]. Brain MRI may not necessary for all girls with CPP due to a lower risk of having other CNS abnormalities. The prevalence of unsuspected intracranial lesions is 8–13% in girls and decreases with age [6]. Among girls with CPP (onset age of 6–8 years), unsuspected pathology and tumors were only involved in 2–7% and 1% of the them, respectively [4]. Brain MRI continues to be routinely performed to identify potential intracranial lesions in all girls with CPP [6,7,8,9]. Whether girls with central precocious puberty (CPP) should undergo routine brain magnetic resonance imaging (MRI) to identify potential intracranial pathologies is controversial
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