Is surgery effective for treating hypothalamic hamartoma causing isolated central precocious puberty? A systematic...

Area of Science:

• Neuroendocrinology
• Pediatric Endocrinology
• Neurosurgery

Background:

• Central precocious puberty (CPP) can be caused by hypothalamic hamartoma (HH).
• Treatment options for CPP associated with HH are evolving.
• The role of surgical intervention requires clarification.

Purpose of the Study:

• To review the efficacy of surgical resection for hypothalamic hamartoma (HH) causing central precocious puberty (CPP).
• To evaluate surgical outcomes based on hamartoma type and resection extent.

Main Methods:

• Systematic literature review following PRISMA guidelines.
• Inclusion of studies reporting surgical management of isolated CPP due to HH.
• Analysis of 103 patients from 33 studies.

Main Results:

• Pedunculated HH: 73.6% cured, 17.1% partial relief. Total resection (TR) of pedunculated HH led to 88.88% cure rates.
• Sessile HH: Only 11.1% cured, with surgery often ineffective for partial resections.
• Psychological symptoms improved in most patients; no mortality, but 3.7% experienced complications like 3rd nerve palsy.

Conclusions:

• Surgical resection is a viable option for select patients with HH-induced CPP, particularly those with small, pedunculated hamartomas.
• Total resection of pedunculated HH yields high success rates.
• While GnRH analogs are standard, surgery offers an alternative for specific cases, balancing risks and benefits.