Routine Screening by Brain Magnetic Resonance Imaging Is Not Indicated in Every Girl With Onset of Puberty Between the Ages of 6 and 8 Years

Pedicelli, Stefania; Alessio, Paola; Scirè, Giuseppe; Cappa, Marco; Cianfarani, Stefano

doi:10.1210/jc.2014-2702

Cited by 80 publications

(78 citation statements)

References 37 publications

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“…In this single-center cohort of patients with SS and PP, a pituitary microadenoma was identified in 18.5% ( n = 346) and 22.8% ( n = 215), respectively. The incidences we report are notably higher than in previous studies of patients with GHD (0.5%) [2] and PP (1.7–5%) [3, 4]. Our study included MRIs performed over a time period where increased scanner resolution and other modern imaging techniques, such as dynamic imaging and increased magnet strength, may have improved detection of microadenomas.…”

Section: Discussionmentioning

confidence: 87%

“…The rate of intracranial pathologic lesions causing SS/GHD may be larger because our series excluded subjects who had an MRI obtained for other pituitary hormone abnormalities or for nonpituitary reasons that found a mass that was also causing SS. Recent studies have suggested that in PP patients, brain MRIs may have frequent incidental findings without detecting any pathologic findings in 6- to 8-year-old girls [4]. More research is needed to better define patients with SS and PP who are at higher risk of undiagnosed pathologic lesions who would benefit most from MRI to reduce the risk of incidental findings, improve safety, and reduce cost.…”

Section: Discussionmentioning

confidence: 99%

“…Up to 26% of patients with GHD may have an abnormal finding on brain imaging [2]. Database review of GHD patients [2] and chart review of precocious puberty (PP) patients [3, 4] found pituitary microadenomas in 0.5% and 1.9–5%, respectively.…”

Section: Introductionmentioning

confidence: 99%

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Incidence and Outcomes of Pituitary Microadenomas in Children with Short Stature/Growth Hormone Deficiency

2018

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Background/Aims: Patients with short stature (SS)/growth hormone deficiency (GHD) and precocious puberty (PP) undergo brain MRI to evaluate for structural brain abnormalities or pituitary lesions, and pituitary microadenomas are a common finding. Theoretically, a mass effect from these lesions could cause GHD and growth hormone treatment could cause them to enlarge, but they should not cause PP, at least in females. Methods: We investigated if pituitary microadenomas cause GHD by comparing their incidence in patients with SS/GHD to that in females with PP. We performed a retrospective chart review of patients with these disorders who had a brain MRI between 2000 and 2013. Results: The incidence of microadenoma was high in both groups, 18.5% for SS (n = 346) and 21.1% for PP females (n = 194), but did not differ between groups (p = 0.46). In patients with microadenomas, repeat imaging showed resolution in 58% (SS, n = 33) and 67% (PP females, n = 21). Importantly, none of the lesions grew, even in patients treated with growth hormone. Conclusions: Pituitary microadenomas are common in children with GHD/SS and PP, but it does not appear that they are a cause of GHD. They appear to be of limited clinical significance and should not be considered a contraindication to growth hormone therapy.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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Incidence and Outcomes of Pituitary Microadenomas in Children with Short Stature/Growth Hormone Deficiency

2018

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“…MRI imaging of the head has the highest sensitivity for detecting masses related to the pituitary and hypothalamic regions but it is not warranted for all patients with a suspicion for abnormal puberty. Rather, recent data reports that it is unclear if girls older than 6 years require MRI in the absence of a suspicion for an intracranial mass [11]. As noted earlier, ovaries can be imaged with ultrasound to rule out an adnexal mass, and imaging of the adrenal glands can be accomplished with CT.…”

Section: Physical Signs Of Pubertymentioning

confidence: 99%

Puberty-Defining Normal and Understanding Abnormal

Silva

Tschirhart

2016

Curr Treat Options Peds

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“…Precocious puberty secondary to the activation of the hypothalamic-pituitary-gonadal axis is termed central precocious puberty (CPP). CPP may be either idiopathic or associated with central nervous system abnormalities, such as hamartomas and tumors, idiopathic CPP (ICPP) being the most frequent diagnosis in girls [24,25]. The pathophysiology of ICPP is unknown, but girls aged 6-8 years with the onset of puberty may represent the extreme variant of the age range of the onset of normal puberty [26].…”

Section: Introductionmentioning

confidence: 99%

Serum Levels of Polybrominated Diphenyl Ethers in Girls with Premature Thelarche

et al. 2016

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Background/Aims: Polybrominated diphenyl ethers (PBDEs) are widely used as flame retardants and have shown endocrine disruption properties in experimental studies. The aim of this study was to investigate the association between the exposure to PBDEs and alterations of puberty in girls referred for idiopathic central precocious puberty (ICPP) and premature thelarche (PT). Methods: A case-control study was conducted in 124 girls: 37 girls with ICPP (mean age 7.4 ± 0.9 years), 56 with PT (mean age 5.7 ± 2.1 years) and 31 controls (mean age 5.4 ± 1.9 years). PBDE serum concentrations, hormone levels and anthropometry were assessed. PBDE concentrations were corrected for total serum lipid content. Individual exposure to PBDEs was evaluated through ad hoc questionnaires. Results: PBDE serum concentrations corrected for total lipid content were significantly higher in girls with PT (mean 1.49 ± 0.63 log ng/g) than in controls (mean 1.23 ± 0.54 log ng/g; p < 0.05). PT girls showed higher levels of PBDE than ICPP girls (1.49 ± 0.63 vs. 1.37 ± 0.49 log ng/g), though this was not significant. An analysis of the questionnaires revealed no significant differences in exposure between the three groups. Conclusion: Our findings suggest that higher concentrations of serum PBDEs are associated with PT in girls.

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Routine Screening by Brain Magnetic Resonance Imaging Is Not Indicated in Every Girl With Onset of Puberty Between the Ages of 6 and 8 Years

Abstract: Our data cast doubt on the need of routine screening by brain MRI in girls with idiopathic CPP older than 6 years. Evidence-based criteria to drive clinical decision making about the use of MRI are lacking.

Cited by 80 publications

References 37 publications

Incidence and Outcomes of Pituitary Microadenomas in Children with Short Stature/Growth Hormone Deficiency

Incidence and Outcomes of Pituitary Microadenomas in Children with Short Stature/Growth Hormone Deficiency

Puberty-Defining Normal and Understanding Abnormal

Serum Levels of Polybrominated Diphenyl Ethers in Girls with Premature Thelarche

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