Prevalence of cranial MRI findings in girls with central precocious puberty: a systematic review and meta-analysis

Abstract

Background Some pediatric endocrinologists recommend that girls with central precocious puberty (CPP) have cranial magnetic resonance imaging (MRI) performed only if they are younger than 6 years of age. However, no practice guidelines exist. The objective of this review was to assess the frequency of intracranial lesions in girls with CPP. Content We searched six electronic databases (PubMed, Cochrane, Web of Science, SCOPUS, ProQuest, and Dissertation & Theses) from 1990 through December 2015. We included studies on girls with CPP and MRI data. Case reports, case series, studies from the same author/group with the same patient population, and studies with conditions predisposing to CPP were excluded. Two physicians independently reviewed the search results and extracted data. A random-effects model was used to obtain pooled prevalence of positive MRI's across studies. Heterogeneity among studies was evaluated with the Q-statistic. Publication bias was assessed with funnel plots and Egger's test. Pooled prevalence was computed by age group. A linear regression assessed the relationship between intracranial lesion prevalence and healthcare availability. We included 15 studies with a total of 1853 girls <8 year old evaluated for CPP. Summary The pooled prevalence from all studies was 0.09 [95% confidence interval (CI) 0.06-0.12]. There was a significant heterogeneity, indicating the appropriateness of a random effects model in computing pooled prevalence. In the few studies stratified by age group, pooled prevalence was 25% in girls <6 years vs. 3% in girls 6-8 of age. Outlook Our results support that the benefit of routine MRIs in girls with CPP older than 6 years of age without any neurological concerns is not clear-cut.

Do Most 7- to 8-Year-Old Girls with Early Puberty Require Extensive Investigation and Treatment?

“…Some studies have shown that the incidence of CNS lesions is very low in girls with CPP who are more than 6 years of age. 20,24 Thus, the authors recommended that only selected girls undergo cranial MRI. There are other studies, however, that have concluded the opposite.…”

Precocious puberty and Chiari I malformation with syrinx: a case report of an unusual presentation of Costello syndrome

“…Although the vast majority of CPP in girls is idiopathic, rarely, it can be associated with monogenic conditions, tumor formation or other cranial abnormalities [8]. Recent recommendations advise against routine brain MRI in girls with CPP beginning after age 6, as literature reports cranial findings are discovered in a minority of cases of CPP, of which only 1.6% are actionable tumors requiring treatment [9].…”

Update on central precocious puberty: from etiologies to outcomes

“…Because some of these rates include incidental lesions, the actual prevalence of brain tumors and other pathology requiring intervention is even smaller [34]. A meta-analysis based on 15 studies comprising a total of 1853 patients found an overall rate of abnormal MRIs of 9% which decreased to 7% when only girls with CPP older than 6 years were included (35). Based on these data and in light of discussions regarding the decreasing age of normal puberty, it is hard to justify routine brain MRI scanning in all girls presenting with puberty before the age of 8.…”