Cranial MRI Abnormalities and Long-term Follow-up of the Lesions in 770 Girls With Central Precocious Puberty

Abstract

Context Central precocious puberty(CPP) may arise from central nervous system(CNS) lesions in a few affected girls. Recently, the incidence of girls with CPP has increased mostly in 6-8 year-olds, in whom the necessity of magnetic resonance imaging(MRI) is debated. Objective To investigate the frequency, long-term outcome and potential predictors of CNS lesions in a large cohort of girls with CPP. Design and Method A multi-center cohort of 770 Turkish girls with CPP who had systematic cranial MRI between 2005-2017. Age at puberty onset was < 6 years in 116 and 6-8 years in 654. CNS lesions were followed until final decision(6.2±3.1years). Potential predictors of CNS lesions were evaluated by univariate analyses. Results 104/770(13.5%) girls had abnormal brain MRI. Of these, 2.8% were previously known CNS lesions, 3.8% had newly detected and causally related CNS lesions, 3.1 % were possibly related and 3.8% were incidental. Only two(0.25%) neoplastic lesions (one low grade glioma and one meningioma) were identified; neither required intervention over follow-up of 6 and 3.5 years respectively. Age at breast developmen <6 years [OR(95%CI); 2.38(1.08-5.21)] and the peak LH/FSH ratio >0.6 [OR(95%CI); 3.13 (1.02-9.68)] were significantly associated with CNS lesions. However, both patients with neoplastic lesions were >6 years old. Conclusion Although age and LH/FSH ratio are significant predictors of CNS lesions, their predictive power is weak. Thus, systematic MRI seems to be the most efficient current approach to avoid missing an occult CNS lesion in girls with CPP, despite the low likelihood of finding a lesion requiring intervention.

An Approach to the Evaluation and Management of the Obese Child With Early Puberty

“…Using a BMI Z-score cutoff of > 0.5, they found no significant association (positive or negative) between BMI and risk of CNS abnormalities [ 68 ]. Although the number of individuals with CNS findings in this study was small, similar studies have also found no difference in BMI SDS between girls with CPP and normal vs abnormal imaging [ 67 , 71 , 74 ]. In fact, none of these studies identified any strong clinical or biochemical predictors of CNS abnormalities and therefore continued to recommend routine imaging in girls younger than 8 years.…”

“…Indeed, younger age is the strongest predictor of CNS pathology, and MRI is routinely recommended in all girls younger than 6 years [ 69 , 70 ]. The benefit of neuroimaging in girls with CPP older than 6 years of age remains controversial, with some studies in support [ 11 , 67 , 71 ] and other studies against routine MRI [ 63 , 65 , 70 , 72 , 73 ].…”

Early Normal Puberty and Accelerated Puberty in Girls: How Can We Avoid Unnecessary Treatment and Identify Children Who Are Likely to Benefit from Gonadotropin-Releasing Hormone Agonist Treatment?

“…4 The fact that the median age of treatment in the USA is 9 years and 11.6%-15% of the cases in whom treatment is initiated are younger than 8 years and the median age of 770 girls in whom treatment is initiated in a multicenter study in Turkey is 7.9 ± 1.35 years suggests that the majority of the cases in whom GnRHa treatment is initiated are between 7 and 9 years of age and mostly in the 8-9 age group. 2 , 5 In addition, recent reports from Turkey and Denmark confirm that the majority of the cases in whom treatment was initiated were in the idiopathic group. 5 , 6 …”

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

“…2,3) Several researchers have reported the prevalence of CNS abnormalities detected on brain MRI in CPP. [4][5][6] Clinical or laboratory factors that can predict abnormal findings on brain MRI in patients diagnosed with CPP have not yet been identified. Some researchers reported that basal luteinizing hormone (LH) and peak LH were statistically significantly increased when CNS abnormalities were present.…”

“…Several researchers have reported the prevalence of CNS abnormalities detected on brain MRI in CPP [ 4 - 6 ]. Clinical or laboratory factors that can predict abnormal findings on brain MRI in patients diagnosed with CPP have not yet been identified.…”