Marmara University, School of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Istanbul, Turkey.
Medipol University, School of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Istanbul, Turkey.
J Clin Endocrinol Metab. 2021 Jun 16;106(7):e2557-e2566. doi: 10.1210/clinem/dgab190.
Central precocious puberty (CPP) may arise from central nervous system (CNS) lesions in a few affected girls. Recently, the incidence of girls with CPP has increased mostly in 6-8 year olds, in whom the necessity of magnetic resonance imaging (MRI) is debated.
To investigate the frequency, long-term outcome and potential predictors of CNS lesions in a large cohort of girls with CPP.
A multicenter cohort of 770 Turkish girls with CPP who had systematic cranial MRI between 2005 and 2017. Age at puberty onset was <6 years in 116 and 6-8 years in 654. CNS lesions were followed until final decision(6.2 ± 3.1 years). Potential predictors of CNS lesions were evaluated by univariate analyses.
A total of 104/770 (13.5%) girls had abnormal brain MRI. Of these, 2.8% were previously known CNS lesions, 3.8% had newly detected and causally related CNS lesions, 3.1 % were possibly, related and 3.8% were incidental. Only 2 (0.25%) neoplastic lesions (1 low grade glioma and 1 meningioma) were identified; neither required intervention over follow-up of 6 and 3.5 years respectively. Age at breast development <6 years (odds ratio [OR] 2.38; 95% CI 1.08-5.21) and the peak luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio >0.6 (OR 3.13; 95% CI 1.02-9.68) were significantly associated with CNS lesions. However, both patients with neoplastic lesions were >6 years old.
Although age and LH/FSH ratio are significant predictors of CNS lesions, their predictive power is weak. Thus, systematic MRI seems to be the most efficient current approach to avoid missing an occult CNS lesion in girls with CPP, despite the low likelihood of finding a lesion requiring intervention.
中枢性性早熟（CPP）可能由少数受影响女孩的中枢神经系统（CNS）病变引起。最近，CPP 女孩的发病率大多增加到 6-8 岁，其中磁共振成像（MRI）的必要性存在争议。
在一个大型 CPP 女孩队列中，研究 CNS 病变的频率、长期结果和潜在预测因素。
2005 年至 2017 年间，对 770 名土耳其 CPP 女孩进行了系统的颅 MRI。青春期开始年龄<6 岁者 116 例，6-8 岁者 654 例。CNS 病变一直随访至最终决定（6.2±3.1 年）。通过单因素分析评估 CNS 病变的潜在预测因素。
770 例女孩中共有 104 例（13.5%）脑 MRI 异常。其中，2.8%为已知 CNS 病变，3.8%为新发现的、有因果关系的 CNS 病变，3.1%为可能相关，3.8%为偶然相关。仅发现 2 例（0.25%）肿瘤病变（1 例低度胶质瘤，1 例脑膜瘤）；随访 6 年和 3.5 年，均无需干预。乳房发育年龄<6 岁（比值比[OR]2.38；95%可信区间 1.08-5.21）和黄体生成素/卵泡刺激素（LH/FSH）峰值比>0.6（OR 3.13；95%可信区间 1.02-9.68）与 CNS 病变显著相关。然而，有肿瘤病变的患者年龄均>6 岁。
尽管年龄和 LH/FSH 比值是 CNS 病变的显著预测因素，但它们的预测能力较弱。因此，尽管发现需要干预的隐匿性 CNS 病变的可能性较低，但系统 MRI 似乎是避免遗漏 CPP 女孩隐匿性 CNS 病变的最有效方法。
