Clinical, Endocrine and Neuroimaging Findings in Girls With Central Precocious Puberty

Abstract

Context The etiology of central precocious puberty (CPP) include a spectrum of conditions. Girls with CPP younger than 6 should undergo cranial magnetic resonance imaging (MRI), but it remains controversial whether all girls who develop CPP between the ages of 6 and 8 require neuroimaging examination. Objective To investigate the frequency of brain MRI abnormalities in girls diagnosed with CPP and the relationship between maternal factors, their age at presentation, clinical signs and symptoms, hormonal profiles and neuroimaging findings. Methods Data from 112 girls who showed clinical pubertal progression before 8 years of age who underwent brain MRI were collected between January 2005 and September 2019. Results MRI was normal in 47 (42%) idiopathics (I), 54 (48%) had hypothalamic-pituitary anomalies (HPA) and/or extra-HP anomalies (EHPA), and 11 (10%) had brain tumors or tumor-like conditions (BT/TL), including three with neurological signs. Associated pre-existing disorders were documented in 16. Girls with BT/TL had a higher LH peak after GnRH test (P=0.01) than I, and those over 6 years had a higher cranio-caudal diameter of the pituitary gland (P=0.01); their baseline FSH and LH (P=0.004), and peak FSH (P=0.01) and LH (P=0.05) values were higher than I. Logistic regression showed maternal age at menarche (P=0.02) and peak FSH (P=0.02) as BT/TL risk factors. Conclusions MRI provides valuable information in girls with CPP by demonstrating that less than half have a normal brain MRI and that few can have significant intracranial lesions after the age of 6, despite the absence of suggestive neurological signs.

MRI evaluation of cranial pathologies in rapidly progressive early puberty cases aged 8-9

“…Although basal gonadotropin levels, stimulated FSH and LH, and basal estradiol levels have been considered warning signs for intracranial malignant lesions in 6 years old cases (8,25,31,32,34), we did not detect malignant or gross intracranial pathologies in our study. The higher number of incidental findings, particularly pineal cysts, and the absence of malignant findings may contribute to this outcome.…”

“…In their study, Fava and et al. ( 32 ) examined 112 cases of central precocious puberty (CPP) and identified pituitary hypoplasia in one patient, who also presented with deficiencies in growth and thyroid hormones. Baş et al.…”

“…Pituitary hypoplasia was included among the pathological findings (9, 19,20), but this remains a relatively unexplored topic in the literature. In their study, Fava and et al (32) examined 112 cases of central precocious puberty (CPP) and identified pituitary hypoplasia in one patient, who also presented with deficiencies in growth and thyroid hormones. Başet al (33) highlighted a case of CPP development linked to a POU1F1 gene mutation, which was associated with multiple hormone deficiencies.…”

Childhood obesity and central precocious puberty

“…Therefore, the evaluation of LH peaks after GnRH testing is the gold standard in the biochemical diagnosis of CPP. The combined detection of secondary sexual characters, bone age, hormone levels, pelvic ultrasound and cranial MRI could increase the sensitivity and accuracy for CPP diagnosis (4,5).…”