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Neuroimaging in 205 consecutive Children Diagnosed with Central Precocious Puberty in Denmark
Anna B Hansen1, Christoffer H Renault1, Ditte Wøjdemann1
1Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Insights
Intracranial pathology is a rare cause of central precocious puberty (CPP) in children, primarily affecting younger boys. Routine brain MRI may be reserved for high-risk patients, particularly those under 6.1 years.
Area of Science:
- Pediatric Endocrinology
- Pediatric Neurology
- Radiology
Background:
- Brain magnetic resonance imaging (MRI) is standard for evaluating central precocious puberty (CPP) to detect intracranial pathology.
- Understanding the incidence of neuroimaging findings in CPP is crucial for refining diagnostic guidelines.
Purpose of the Study:
- To evaluate the occurrence of pathological findings on neuroimaging in children diagnosed with CPP.
- To determine the association between age, sex, and intracranial pathology in CPP.
Main Methods:
- Retrospective analysis of 1544 children referred for early puberty signs (2009-2019).
- Focused on 205 children with confirmed CPP who underwent brain MRI.
- Abnormal MRI findings were re-evaluated by a neuroradiologist.
Main Results:
- Intracranial pathology was identified in 6 out of 205 children (2.9%) with CPP.
- Pathology incidence was 1.8% in girls and 12.5% in boys.
- All identified pathologies occurred in children aged 1.5 to 6.1 years.
Conclusions:
- Organic causes of CPP are more common in younger boys.
- The age threshold for routine brain MRI in girls could potentially be lowered to six or seven years, excluding those with rapid progression or neurological symptoms.
- Intracranial pathology is rare in CPP and predominantly seen in younger children, supporting selective MRI use in high-risk individuals.
Introduction:
A brain magnetic resonance image (MRI) is considered part of routine evaluation in children diagnosed with central precocious puberty (CPP) to rule out intracranial pathology. We evaluated the occurrence of pathological findings on neuroimaging among children diagnosed with CPP.
Methods:
A retrospective study based on an evaluation of 1544 children referred with early signs of puberty from 2009-2019. Of these, 205 children (29 boys) with confirmed CPP had a brain MRI performed, and we report MRI results, pubertal stage, bone age, and hormonal analyses. All abnormal MRI results were re-evaluated by a trained neuroradiologist.
Results:
A new intracranial pathology was found by brain MRI in 6 out of 205 patients aged 1.5 to 6.1 years. The occurrence of intracranial pathology was 3/162 (1.8%) and 3/24 (12.5 %) in girls and boys respectively.
Conclusion:
Organic causes of precocious puberty are more frequent in boys with CPP than in girls. No cases of organic CPP were seen above age 6.1 years of age. The age cut off value for routine brain MRI could be lowered to seven or perhaps even six years of age for girls, except in rapidly progressing puberty or presence of neurological symptoms.
Impact:
In our study of children with central precocious puberty (CPP), intracranial pathology is a rare cause and occurs only in younger children. It supports the general trend, that younger children are at higher risk of having organic causes to CPP and supports the clinical practice, that only high-risk patients with CPP should undergo routine brain MRI.
