Brain imaging in girls with central precocious puberty onset between the ages of six and eight: a retrospective observational study.

BACKGROUND

Brain imaging is recommended for girls with central precocious puberty (CPP) that begins before the age of six; however, its necessity remains controversial for those with onset between the ages of six and eight. We aim to evaluate the role of brain imaging in girls experiencing the onset of puberty within this age range.

METHODS

This retrospective observational study evaluated 162 girls diagnosed with CPP in Hong Kong from January 2010 to December 2020. Brain magnetic resonance imaging (MRI) findings for 139 of these girls were reviewed. Clinical findings of 125 girls who entered puberty between the ages of six and eight were analyzed.

RESULTS

15.8% (22 of 139) of girls with CPP had abnormal MRI findings. The incidence was lower in girls who began puberty between six and eight years of age (13.6%, 17 of 125 girls) compared to those who started puberty before the age of six (35.7%, 5 of 14 girls), with a statistically significant difference (p = 0.047). Abnormal MRI findings in the 17 girls who started puberty between six and eight years of age included: a RCC (n = 6), a pituitary microadenoma (n = 4), a pituitary macroadenoma (n = 1), either a RCC or a pituitary microadenoma (n = 2), a pineal cyst (n = 1), an arachnoid cyst in the right posterior fossa with a RCC (n = 1), pituitary hyperplasia along with a RCC and an arachnoid cyst in the right middle fossa (n = 1), and a duplicated posterior pituitary gland (n = 1). None of the girls had neurological concerns or required neurosurgical interventions during the follow-up period of 4.6 ± 1.9 years. Among the 125 girls who began puberty between the ages of six and eight, no significant differences in clinical findings were observed between those with normal and abnormal MRIs.

CONCLUSIONS

The likelihood of identifying clinically significant intracranial pathologies through routine brain imaging in girls who started puberty between the ages of six and eight is low. In the absence of neurological concerns, watchful observation may be appropriate, provided that parents are fully informed of the minimal risk of overlooking underlying intracranial pathology.