Incidental pineal gland cyst in girls with early onset of puberty

Abstract

Background The causes of an early onset of puberty are still not clearly defined and may vary from subject to subject. In girls, even if 90% of early puberty is idiopathic, magnetic resonance imaging (MRI) of the brain is performed to exclude secondary causes of precocious puberty, in particular pathological lesions as hypothalamic tumours (hamartoma). In some cases, other intracranial lesions are considered as incidental findings. Aim of the study is evaluating the prevalence of abnormal intracranial lesions detected by brain magnetic resonance imaging MRI with particular focus on the prevalence of pineal gland cysts in the diagnostic work-up of girls with central precocious puberty (CPP) as onset before 8 years and central early puberty (CEP) as onset before 10 years. Material and methods MRI data of girls referred from January 2010 to December 2015 to the Pediatric Endocrinology Unit of University of Pavia for early onset of breast development were collected. Results We collected 123 MRI data of girls referred to the Pediatric Endocrinology Unit of University of Pavia for early onset of breast development in the study period. Out of them, 25 (20.3%) had cerebral abnormalities and 15 (12.2%) had pineal gland cysts. No significant differences were noted in auxological, ultrasound and hormonal parameters at diagnosis among girls with or without pineal cysts. Patients have been observed for at least three years after the discontinuation of therapy. None of our patients had an unfavorable evolution. Conclusions Although pineal cysts seem to be not involved in the onset of puberty, the relevance of the finding remains controversial. Our study wants to provide further insight into the incidence of pineal cysts in pubertal advances. Of note, pineal cysts are often asymptomatic and do not evolve over time.

Pineal cysts may promote pubertal development in girls with central precocious puberty: a single-center study from China

“…It is generally believed that the higher the above indicators are, the faster the pubertal development process is (18). It has been reported that CPP may be related to pineal cysts (9), but some studies have reached the opposite conclusion, suggesting that pineal cysts are an occasional phenomenon in girls with CPP (11). In this study, CPPdiagnosed girls with pineal cysts meeting the study criteria were defined as the cyst group, and CPP-diagnosed girls without cysts were defined as the non-cyst group by 1:1 matching according to age and BMI.…”

“…In some cases, ataxia, motor and sensory disorders, mood disorders, epilepsy, circadian rhythm disorders, CPP, and secondary Parkinson's disease have been reported (20). Symptomatic cysts range in size from 7 to 45 mm, whereas asymptomatic cysts are usually <10 mm in diameter (11). According to the grouping criteria in previous literature (13), the girls were divided into three groups according to cyst size: ≤5 mm, 5.1-9.9 mm, and ≥10 mm.…”

“…Melatonin, a natural indoleamine, is synthesized from tryptophan via 5-hydroxytryptamine with the participation of vitamin D; since it is secreted mainly at night, it is known as the dark hormone (24). Melatonin receptors are widely distributed in the HPGA and inhibit the HPGA at various levels, such as in the hypothalamus, pituitary gland, and gonads, thus inhibiting the initiation of puberty (11,25). Melatonin synthesis is regulated by sex, age, season, sunlight exposure, sleep time, and other factors (26).…”

“…Some previous studies have reported cases of precocious puberty with pineal cysts (9). Nevertheless, some scholars believe that pineal cysts are an occasional phenomenon in children with precocious puberty (11,12), but whether there is a correlation between the two is still inconclusive.…”

Intracranial Pathologies and Endocrine Results: Single Pediatric Endocrinology Center Experience

“…MRI in girls aged 6-8 years is still debated because the incidence of cranial abnormalities in this age group is minimal (21)(22)(23)(24)(25)(26). The most prevalent CNS lesions are hypothalamic hamartomas in the tuber cinereum, which are typically asymptomatic (27,28). In a study in Taiwan on 251 girls with CPP, 190 (75.70%) of the patients had normal MRIs.…”