Endocrine Abstracts

JOINT853

Context: Central precocious puberty (CPP) has a complex etiology that involves a variety of conditions. Although approximately 90% of cases in girls are classified as idiopathic, a subset presents additional imaging findings that may have clinical significance.

Objective: To compare the frequency of brain magnetic resonance imaging (MRI) findings between girls with CPP and a control group and analyze, in CPP patients, their relationship with pubertal diagnosis and progression.

Methods: Data were collected between April 2017 and November 2024 from 102 girls who exhibited clinical pubertal progression before the age of 8 and underwent brain MRI, as well as 25 girls and 72 boys with other conditions, the majority diagnosed with idiopathic short stature, who also underwent brain MRI. The data evaluated were chronological age (CA), height SDS (zH), body mass index SDS (zBMI), bone age (BA), LH levels at diagnosis and after follow-up.

Results: Abnormal MRI findings were observed in 38 girls (37.3%) from the CPP group and in 19 individuals (19.6%) from the control group (z test, P <0.05). Among the 38 abnormalities in the CPP group, 33 (32.4%) where classified as indeterminate (I) (e.g., inter-hypothalamic adhesion, pars intermedia cyst, pineal gland cyst), while 5 (4.9%) were classified as pathologic lesions (PL) (e.g., hypothalamic-optochiasmatic glioma, hydrocephalus). In the control group, all 19 abnormalities were limited to I, with no cases of PL. Girls with CPP due to PL exhibited a shorter interval between the diagnosis and the start of pubertal suppression therapy (P = 0.017) and showed less advanced bone age relative to chronological age at diagnosis (P = 0.035). No significant differences were found among the CPP subgroups in terms of age at puberty onset, age at diagnosis, BA at diagnosis, bone age-corrected height SDS, baseline LH, LH peak after GnRH stimulation, CA at initiation and discontinuation of pubertal suppression therapy, or age at menarche.

Conclusions: It is essential to perform MRI on all girls with CPP, including those aged 6-8 years, since they may also have undiagnosed PL. There were no differences in CPP group patients with or without abnormal MRI findings in relation to clinical or laboratory data. While indeterminate findings are more frequent in girls with CPP compared to the control group, these cannot yet be established as a cause or indicative of a different progression of puberty.

Key words: precocious puberty; MRI; glioma; inter-hypothalamic adhesion.