Background: Organic lesions in males with central precocious puberty (CPP) have been reported in 40% of cases. This high prevalence decreases (2029%) when patients with previously diagnosed alterations of central nervous system (CNS) are excluded. Reported predictors of organic lesions are age at puberty onset, bone age, BMI, LH peak response and testosterone levels.
Objective and hypotheses: To determine the prevalence and type of intracranial lesions in males with CPP and to identify clinical and biochemical predictors of brain abnormalities.
Method: All males diagnosed with CPP at a tertiary pediatric center were included. Patients with known CNS alterations, genetic syndromes or known endocrine disorders were classified as having secondary CPP (sCPP); the remaining as isolated CPP (iCPP). All patients underwent hypothalamus-pituitary MRI and the findings were classified as: normal, incidentalomas or organic lesions.
Results: A total of 64 boys were included in the study; iCPP was diagnosed in 78.1% of cases (50/64). The comparison between iCPP and sCPP showed that iCPP patients had higher height SDS at diagnosis (P=0.014), higher BMI SDS (P=0.037) and lower prolactin levels (P=0.001), probably related to the underlying diseases in sCPP patients. iCPP males showed normal MRI in 78% of cases (39/50), incidentalomas in 10% (5/50) and organic lesions in 12% (6/50). These lesions were represented by 3 microadenomas (2 of them not confirmed at a second evaluation), 2 hamartomas and 1 ganglioglioma. As microadenomas are often considered incidentalomas in pediatric population with CPP, after their exclusion the prevalence of organic lesions decreased to 6%. No predictive parameter of organic lesions was found. Radiological follow-up of the organic lesions showed no evolution after 2-years follow-up.
Conclusion: In males with CPP the prevalence of organic lesions is lower than previously reported after excluding patients with known predisposing conditions.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology