Pathological and Incidental Findings in 403 Taiwanese Girls With Central Precocious Puberty at Initial Diagnosis

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.

Pathological brain lesions in girls with central precocious puberty at initial diagnosis in Southern Vietnam

“…According to recent literature [ 6 , 7 ], brain insults were classified into 3 groups as determined in Table 1 . In total, 44 girls with CPP (17.1%) had brain lesions, of which 34.0% (n=15), 38.6% (n=17), and 27.4% (n=12) presented pathological findings, brain lesions with questionable relationships to CPP, and incidental findings, respectively ( Table 1 ).…”

“…Routine cranial MRI scans are recommended for girls younger than 6 years of age because it is necessary for the early diagnosis of brain tumors and progressive pathologies of CPP. However, the prevalence of hypothalamic hamartoma in children with organic CPP aged 0–6 years was low (0.4%) [ 7 ]. Noteworthy, Yoon et al [ 8 ] found that none of 317 South Korean girls aged 6.9±1.6 years with CPP had pathological brain lesions.…”

Precocious puberty or growth hormone deficiency as initial presentation in Mayer-Rokitansky-kuster-Hauser syndrome: a clinical report of 5 cases

“…Pineal cyst and Rathke cyst were detected by MRI in three of our patients. Recently, the prevalence of pineal cyst (0.8%) and Rathke cyst (2%) have been reported in 251 girls with CPP [ 22 ]. One conceivable explanation is that a cyst somewhat abrogates the normal prepubertal gonadotropin inhibition [ 23 , 24 ].…”

DIAGNOSIS OF ENDOCRINE DISEASE: Sex steroid action in adolescence: too much, too little; too early, too late

“…A B Hansen and others Sex steroids in adolescencel https://eje.bioscientifica.com since NF-1 can be a cause of intracranial tumors related to CPP (26). Factors arguing against brain MR are onset of PP over the age of 6 years and some ethnic groups who have a tendency toward early normal puberty including internationally adopted children, as patients with such factors are more likely to present with ICPP and no intracranial pathology (26,27,28).…”