Isosexual precocious puberty in girls.

Area of Science:

• Pediatric Endocrinology
• Pediatric Neurology
• Diagnostic Imaging

Background:

• Precocious puberty (PP) is defined as the onset of secondary sexual characteristics before age 8 in girls.
• Intracranial abnormalities are a known cause of PP, necessitating thorough investigation.
• Understanding the impact of these abnormalities on hormonal function and treatment response is crucial.

Purpose of the Study:

• To review clinical findings, hormonal reserve, and imaging characteristics in girls with PP.
• To investigate the correlation between intracranial abnormalities and pituitary gonadotrophin reserve.
• To evaluate the efficacy of cyproterone acetate in managing PP.

Main Methods:

• Retrospective review of 47 girls with PP before age 7.
• Assessment of pituitary gonadotrophin reserve and plasma estradiol levels.
• Neurological examination, air encephalography or cranial CT scans, and pelvic ultrasound.
• Evaluation of treatment response to cyproterone acetate.

Main Results:

• 19 out of 39 girls with neuroimaging showed intracranial abnormalities (hamartomas, hydrocephalus, optic glioma, arachnoid cyst).
• No significant difference in luteinizing hormone (LH) and follicle-stimulating hormone (FSH) responses to gonadotropin-releasing hormone (GnRH) stimulation between girls with and without intracranial lesions.
• Pelvic ultrasound revealed ovarian, uterine, and vaginal development consistent with normal puberty.
• Cyproterone acetate treatment in 26 girls led to arrest of breast development and menstruation, with no documented effect on growth.

Conclusions:

• Intracranial abnormalities are common in girls with PP but do not appear to significantly alter pituitary gonadotrophin reserve.
• Pelvic ultrasound findings are similar to normal pubertal development.
• Cyproterone acetate can effectively manage hormonal and physical progression of PP, but its impact on linear growth requires further investigation.