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Idiopathic isosexual central precocious puberty: magnetic resonance findings in 30 patients
S G Robben1, W Oostdijk, S L Drop
1Department of Pediatric Radiology, Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
Brain MRI in idiopathic central precocious puberty revealed pituitary gland enlargement in all patients and structural abnormalities in 13%. Gadolinium contrast enhanced MRI is safe for diagnosing and monitoring these pediatric patients.
Area of Science:
- Pediatric Endocrinology
- Neuroradiology
- Medical Imaging
Background:
- Idiopathic central precocious puberty (ICPP) involves early puberty onset without a clear cause.
- Neurological evaluation is standard, but the role of brain imaging, particularly with contrast, requires definition.
- Assessing brain structure is crucial for ruling out underlying pathologies.
Purpose of the Study:
- To determine the frequency of brain MRI abnormalities in children with ICPP.
- To evaluate the utility of gadolinium contrast in brain MRI for ICPP patients.
- To assess the safety and reliability of contrast-enhanced MRI in this population.
Main Methods:
- Prospective study of 30 patients (29 girls, 1 boy) with ICPP, aged 1.9-11.9 years.
- Brain MRI performed in multiple planes before and after gadolinium contrast (gadopentetate dimeglumine).
- Focused evaluation of the third ventricle region and pituitary gland height.
Main Results:
- Pituitary gland height was increased to adult size in all patients.
- Major structural abnormalities were identified in 4 patients (13%): 3 tuber cinereum hamartomas and 1 gliomatous process.
- Gadolinium contrast did not reveal new abnormalities but improved diagnostic certainty due to lack of enhancement in certain lesions.
Conclusions:
- Contrast-enhanced MRI is a safe and reliable tool for excluding brain abnormalities in children with ICPP.
- MRI is valuable for the follow-up of ICPP patients, especially those with identified structural abnormalities.
- Routine gadolinium contrast administration aids in diagnostic certainty for brain MRI in ICPP.
Abstract:
The purpose of this prospective study was to define the incidence of magnetic resonance imaging (MRI) abnormalities in the brain in patients with idiopathic central precocious puberty without any additional neurological signs and symptoms, and to evaluate the routine use of gadolinium contrast in these patients. 30 patients (29 girls, one boy; age range 1.9-11.9 years) with idiopathic central precocious puberty were studied. MRI of the brain in axial, coronal and sagittal planes was performed before and after administration of gadopentetate dimeglumine, with special attention to the region of the third ventricle. There are three major findings: (1) the height of the pituitary gland is increased up to adult size compared with normal individuals; (2) in four patients (13%) major structural abnormalities were found; three hamartomas of the tuber cinereum and one gliomatous process extending from the chiasm to the optic tract; and (3) the routine use of gadopentetate dimeglumine did not reveal new abnormalities although the lack of enhancement made a positive contribution to diagnostic certainty. We conclude that contrast enhanced MR examination is a safe and reliable method for the exclusion of abnormalities in children with precocious puberty and for the follow-up of those patients in whom abnormalities are present.