Boys with precocious or early puberty: incidence of pathological brain magnetic resonance imaging findings and factors related to newly developed brain lesions

Abstract

PurposeBrain magnetic resonance imaging (MRI) findings and factors predictive of pathological brain lesions in boys with precocious puberty (PP) or early puberty (EP) were investigated.MethodsSixty-one boys with PP or EP who had brain MRI performed were included. PP was classified into the central or peripheral type. Brain MRI findings were categorized into group I (pathological brain lesion known to cause puberty; newly diagnosed [group Ia] or previously diagnosed [group Ib]); group II (brain lesion possibly related to puberty); and group III (incidental or normal findings). Medical history, height, weight, hormone test results, and bone age were reviewed.ResultsBrain lesions in groups I and II were detected in 17 of 23 boys (74%) with central PP, 9 of 30 boys (30%) with EP, and 7 of 8 boys (88%) with peripheral PP. All brain lesions in boys with peripheral PP were germ cell tumors (GCT), and 3 lesions developed later during follow-up. Group I showed earlier pubertal onset (P<0.01) and greater bone age advancement (P<0.05) than group III. Group III had lower birth weight and fewer neurological symptoms than "Ia and II" (all P<0.05).ConclusionEarlier onset of puberty, greater bone age advancement, and/or neurological symptoms suggested a greater chance of pathological brain lesions in boys with central PP or EP. All boys with peripheral PP, even those with normal initial MRI findings, should be evaluated for the emergence of GCT during follow-up.

Central Precocious Puberty: Update on Diagnosis and Treatment

“…In addition, the etiology of CPP differs between the genders. While the majority of girls will have idiopathic CPP, boys are more likely to have a pathological source [1, 6]. Risk factors for CPP include a history of international adoption, as well as congenital or acquired central nervous system insults, such as hypothalamic hamartoma, septo-optic dysplasia, tumor, trauma, infection, or ischemia.…”

High Frequency of <b><i>MKRN3</i></b> Mutations in Male Central Precocious Puberty Previously Classified as Idiopathic

“…Diagnostic confirmation of CPP relies on the demonstration of pubertal basal and/or GnRH-stimulated LH levels [1, 8]. CPP may result from a central nervous system (CNS) lesion, such as hypothalamic hamartoma, astrocytoma, arachnoid cyst or hydrocephalus [1, 9]. When no cause is identified, it is called idiopathic CPP [1].…”

“…Interestingly, idiopathic CPP is almost 10 times less frequent in boys than in girls [10, 11]. Among boys with CPP, a higher prevalence of CNS lesions has been demonstrated (40–90%), indicating the need for brain magnetic resonance imaging (MRI) in all boys with CPP [1, 9, 11, 12]. However, a recent study suggested that the number of cases of male idiopathic CPP is increasing over time [13].…”

Puberdade precoce: condições associadas

“…Sabendo-se que o risco da criança com PPC evoluir com perda estatural na vida adulta é bastante elevado, se seus pais apresentarem estatura abaixo da média populacional, esse agravante assume uma dimensão ainda maior (27) . Quanto menor é a idade de início puberal, maiores são os riscos de tumores como causa de PPC (28) . O início da puberdade aos 6 anos de idade ou menos ocorreu em 60,3% das crianças estudadas na atual pesquisa.…”

“…Como consequência desse retardo, observou-se que, entre aquelas atendidas a partir do segundo ano do aparecimento dos sinais puberais, 83,8% estavam em níveis significativamente mais avançados da puberdade do que as crianças (66,2%) atendidas dentro do primeiro ano do aparecimento dos sinais (p=0,048). Isso mostra como crianças em PPC, quando não tratadas no tempo adequado, sofrem aceleração do processo, exigindo uma maior rapidez nos cuidados, sob pena de maior exposição a conflitos psicológicos, assédio sexual e pior prognóstico para estatura final (27)(28)(29) . Um claro indicador de iniquidade é constatado quando se observa que, entre as crianças atendidas somente no segundo ano após seus pais perceberem os primeiros sinais puberais, 17,8% eram provenientes de famílias com renda mensal de até um salário mínimo, contra 4,3% das crianças atendidas dentro do primeiro ano após o aparecimento dos sinais (p=0,002).…”