ESPE Abstracts

Background: Neuropsychiatric symptoms can be present in patients with central precocious puberty (CPP), with or without abnormalities in brain magnetic resonance imaging (MRI). However, they are especially common in those with CPP-related lesions.

Aim: To assess the prevalence of brain lesions detected by MRI in a cohort of children with CPP and to evaluate the occurrence of neuropsychiatric manifestations.

Patients and Methods: We retrospectively evaluated brain MRIs of 178 children with CPP (154 girls, 86.5%; 24 boys, 13.5%) followed from 1990 to 2023. Brain lesions were classified as congenital or acquired, and as CPP-related or incidental. Neuropsychiatric symptoms were informed by patients or caregivers during consultations or retrieved from medical records.

Results: In girls, normal brain MRI was detected in 86/154 (55.8%). Abnormal brain MRI was identified in the remaining 68 girls (44.2%), with 28 presenting congenital CPP-related lesions (11 hypothalamic hamartoma, 6 hydrocephalus, 3 optic pathway gliomas, 3 myelomeningocele, 2 corpus callosum agenesia, 1 arachnoid cyst, 1 tuberous sclerosis, 1 choroid plexus papilloma) and 40 (26%) with incidental findings (microadenomas, pituitary stalk deviation, pituitary hyperplasia, Rathke cleft cyst, hippocampal alterations). Neuropsychiatric symptoms (delay in neuropsychomotor development, learning difficulties, delay in language, attention deficit hyperactivity disorder, epilepsy, anxiety disorder, panic syndrome, headache, and social phobia) were present in 22.7% of the girls. In boys, normal brain MRI was detected in 5 patients (20.8%). Abnormal brain MRI was identified in the remaining 19 boys (79.2%), with 16 presenting congenital CPP-related lesions (9 hypothalamic hamartoma, 4 hydrocephalus, 2 pinealomas, 1 glioma, 1 with acquired lesion (1 pilocystic astrocytoma) and only 2 with brain MRI showing incidental findings (1 pineal cyst and 1 pituitary microadenoma). Male patients exhibited greater prevalence (70.8%) of CPP-related brain lesions (17/24; P < 0.05) and a higher frequency of neuropsychiatric symptoms (12/24; P < 0.05). Neuropsychiatric symptoms were identified in 26.4% overall, with higher rates (62.2%) in patients with brain abnormalities (28/45, P < 0.05). These symptoms were also identified in patients with normal MRI (11%) and those with incidental findings (21.4%). Children with hamartomas and hydrocephalus exhibited more neuropsychiatric symptoms compared to those with normal brain MRI (P <0.05).

Conclusion: The prevalence of pathological brain lesions was higher among girls with CP P < 6 years old, as well as among boys. Neuropsychiatric symptoms were more prevalent in patients with CPP-related lesions compared to those with normal MRI or incidental findings unrelated to CPP.