Prevalence of Brain Lesions on MRI in Girls With Central Precocious Puberty

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Pathological brain lesions are not common on MRI in girls with central precocious puberty in the absence of signs or symptoms of CNS lesions.

In the absence of signs or symptoms of central nervous system (CNS) lesions, pathological brain lesions are not common in girls with central precocious puberty (CPP), according to study results published in Frontiers in Endocrinology.

While CNS imaging is frequently completed for all boys with CPP, this is not the case for girls due to a lower risk of having other CNS abnormalities. The goal of the current study was to assess the prevalence and type of intracranial findings in girls with CPP and the need for routine brain magnetic resonance imaging (MRI) in this population.

The retrospective study included 403 girls with CPP treated at the pediatric endocrine clinics at Chang Gung Memorial Hospital in Taoyuan, Taiwan. Of these girls, 251 underwent detailed MRI examinations of the hypothalamus and pituitary area and were classified into 3 groups: normal with no relevant abnormalities or pituitary hyperplasia alone, abnormalities of the hypothalamus-pituitary area, and abnormalities of non-hypothalamus-pituitary lesions. Overall, 16 girls were aged <3 years, 42 were aged 3 to 6 years, and 193 were aged 6 to 8 years.

The researchers found no brain alterations in 190 girls (75.70%). In 54 patients (21.51%), there were abnormalities in the hypothalamus-pituitary area unrelated to CPP, and in 7 girls (2.79%) there were abnormalities in the non-hypothalamus-pituitary area. Abnormalities of the hypothalamus-pituitary area were evident in 20.73% of all girls aged 6 to 8 years, 21.43% of those aged 3 to 6 years, and 31.25% of girls aged <3 years (P =.8421).

Pathological findings related to CPP were noted in only 1 patient (0.4%), as imaging revealed hypothalamic hamartoma, the most common brain lesion causing CPP.

Approximately a quarter of the patients (24.3%) had newly diagnosed intracranial pathologies, most of which were incidentalomas and included pituitary microadenoma (12.35%), cyst of pituitary pars intermedia (4.38%), Rathke pouch cyst (1.99%), pituitary hypoplasia (1.59%), and pineal gland cyst (0.8%).

Most of the patients (73.77%) with incidental findings underwent imaging tests during the follow-up period. None of the intracranial abnormalities showed progression and 19.67% regressed during the follow-up. None of the patients had other hormonal abnormalities or underwent surgery.

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The study had several limitations, including the single-center, retrospective design; unknown data on the prevalence of intracranial lesions among girls who did not undergo brain imaging; and potential unmeasured confounders.

“These data question the routine use of brain MRI in all girls with CPP, especially in those who are healthy without neurologic symptoms,” concluded the researchers.

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Chiu C-F, Wang C-J, Chen Y-P, Lo F-S. Pathological and incidental findings in 403 Taiwanese girls with central precocious puberty at initial diagnosis [published online May 5, 2020]. Front Endocrinol (Lausanne). doi:10.3389/fendo.2020.00256