ESPE Yearbook of Paediatric Endocrinology

Brief summary: This Danish single-center retrospective study evaluated the occurrence of pathological findings on neuroimaging among children diagnosed with central precocious puberty (CPP).

CPP incidence has been increasing over the last four decades (1) and is more prevalent in females than in males. Most cases are idiopathic (2) but brain magnetic resonance imaging (MRI) is routinely performed in order to exclude rare pathological causes.

This study evaluated 205 children (176 girls, 29 boys) with clinical and biological signs of CPP over a period of 10 years. On their brain MRI, 6 patients, 3/164 (1.9%) girls and 3/24 (12.5%) boys, had a newly diagnosed intracranial pathology. Most of these findings were hypothalamic hamartomas (4/6). All 6 of these patients had pubertal onset before 6.1 years of age, significantly younger than children with idiopathic CPP.

These findings are in concordance with previous studies (3,4), which reported tendencies towards a lower age at pubertal onset in patients with newly found intracranial pathologies causing CPP in both sexes. The authors cite a meta-analysis that included 1853 patients and reporting a low incidence (1.6%) of tumors that required any intervention. Based on their observation and the cited meta-analysis, the investigators suggest to lower the age threshold for performing a routine brain MRI for CPP to 7 years of age in girls (except in patients with rapidly progressing puberty or presence of neurological symptoms), but suggest to continue to perform a routine MRI in all boys who present with CPP.

References: 1. Eckert-lind C, Busch AS, Petersen JH, Biro FM, Butler G, Bräuner EV, Juul A. Worldwide secular trends in age at pubertal onset assessed by breast development among girls a systematic review and meta-analysis. JAMA Pediatr. 2020; 174(4):e195881. 2. Bräuner EV, Busch AS, Eckert-Lind C, Koch T, Hickey M, Juul A. Trends in the incidence of central precocious puberty and normal variant puberty among children in Denmark, 1998 to 2017. JAMA Netw. Open. 2020; e2015665. 3. Pedicelli, S., Alessio, P., Scirè, G., Cappa, M., Cianfarani, S. Routine screening by brain magnetic resonance imaging is not indicated in every girl with onset of puberty between the ages of 6 and 8 years. J. Clin. Endocrinol. Metab. 2014;99:4455–4461. 4. Chalumeau M, Hadjiathanasiou CG, Ng SM, Cassio A, Mul D, Cisternino M, Partsch CJ, Theodoridis C, Didi M, Cacciari E, Oostdijk W, Borghesi A, Sippell WG, Bréart G, Brauner R. Selecting girls with precocious puberty for brain imaging: validation of European evidence-based diagnosis rule. J Pediatr. 2003;143(4):445–50.