Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Graduate Institute of Clinical Medicine Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
Front Endocrinol (Lausanne). 2020 May 5;11:256. doi: 10.3389/fendo.2020.00256. eCollection 2020.
Whether girls with central precocious puberty (CPP) should undergo routine brain magnetic resonance imaging (MRI) to identify potential intracranial pathologies is controversial. To evaluate the brain MRI results of girls with CPP and identify the clinical and endocrine predictors of brain abnormalities. This retrospective study obtained data from pediatric endocrine clinics at Chang Gung Children's Hospital. From 1997 and 2017, 403 girls were consecutively diagnosed with CPP. After the exclusion of patients with a history of central nervous system (CNS) insults or associated neuropsychiatric symptom or signs, we studied the prevalence of brain abnormalities in 251 girls with CPP who received detailed MRI examinations of the hypothalamus and pituitary area. We also recorded the demographic data of the participants, including the onset of puberty; initial pubertal status; height; weight; uterus and ovary sizes; and basal luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol levels, and the response to GnRH stimulation test. Among the 251 girls with CPP, we observed no brain alterations in 190 (75.70%), abnormalities in the hypothalamic-pituitary (H-P) area in 54 (21.51%), and abnormalities in the non-H-P area in 7 (2.79%). Among the 54 patients that had H-P lesions, we noted pathological findings related to CPP (hypothalamic hamartoma) in only one (0.4%) girl aged below 6 years old. We also identified incidental findings in the other girls with H-P lesions, including non-functioning pituitary microadenomas (12.35%), pituitary pars intermedia cysts (4.38%), Rathke's pouch cysts (1.99%), pituitary hypoplasia (1.59%), and pineal gland cysts (0.8%). The patients that had non-H-P lesions were found to have arachnoid cysts (1.59%), Chiari I malformation (0.4%), prepontine nodule (0.4%), and choroidal fissure cyst (0.4%). Of all the patients with brain lesions, 45 (73.77%) underwent regular MRI follow-up. While none of the H-P and non-H-P lesions showed progression, 19.67% of these regressed during the follow-up. None of the participants exhibited other hormonal abnormalities or underwent surgery. The prevalence of true pathological brain lesions related to CPP in girls without prior symptoms or signs of CNS lesions was low (0.4%). None of the girls with intracranial lesions required further intervention besides the GnRH agonist treatment. These data question the routine use of brain MRI in all girls with CPP, especially in those who are healthy without neurologic symptoms.
中枢性性早熟（CPP）女孩是否应常规行脑磁共振成像（MRI）以确定潜在的颅内病变仍存在争议。本研究旨在评估 CPP 女孩的脑 MRI 结果，并确定脑异常的临床和内分泌预测因素。
本回顾性研究从长庚儿童医院儿科内分泌科获得数据。1997 年至 2017 年期间，连续诊断出 403 例 CPP 女孩。排除有中枢神经系统（CNS）损伤或相关神经精神症状或体征史的患者后，我们研究了 251 例接受详细下丘脑和垂体区域 MRI 检查的 CPP 女孩的脑异常患病率。我们还记录了参与者的人口统计学数据，包括青春期开始；初潮时的青春期状态；身高；体重；子宫和卵巢大小；基础黄体生成素（LH）、卵泡刺激素（FSH）、雌二醇水平以及对 GnRH 刺激试验的反应。
在 251 例 CPP 女孩中，190 例（75.70%）无脑部改变，54 例（21.51%）H-P 区异常，7 例（2.79%）非 H-P 区异常。在 54 例 H-P 病变患者中，我们仅在 1 例（0.4%）年龄<6 岁的女孩中发现与 CPP 相关的病理性发现（下丘脑错构瘤）。我们还在其他 H-P 病变女孩中发现了偶然发现，包括无功能垂体微腺瘤（12.35%）、垂体中间部囊肿（4.38%）、Rathke 囊肿（1.99%）、垂体发育不全（1.59%）和松果体囊肿（0.8%）。非 H-P 病变患者发现蛛网膜囊肿（1.59%）、Chiari I 畸形（0.4%）、桥前结节（0.4%）和脉络膜裂囊肿（0.4%）。所有有脑部病变的患者中，45 例（73.77%）接受了定期 MRI 随访。虽然 H-P 和非 H-P 病变均无进展，但在随访过程中，19.67%的病变消退。所有患者均未出现其他激素异常或接受手术。
在没有 CNS 病变症状或体征的女孩中，与 CPP 相关的真正病理性脑部病变的患病率较低（0.4%）。除 GnRH 激动剂治疗外，颅内病变患者无需进一步干预。这些数据对所有 CPP 女孩常规使用脑 MRI 提出了质疑，尤其是对无神经系统症状的健康女孩。
