Ann Pediatr Endocrinol Metab.  2013 Dec;18(4):183-190. 10.6065/apem.2013.18.4.183.

Boys with precocious or early puberty: incidence of pathological brain magnetic resonance imaging findings and factors related to newly developed brain lesions

• Choi KH
• Chung SJ
• Kang MJ
• Yoon JY
• Lee JE
• Lee YA
• Shin CH
• Yang SW

• KMID: 2266353
• DOI: http://doi.org/10.6065/apem.2013.18.4.183

Abstract

PURPOSE
Brain magnetic resonance imaging (MRI) findings and factors predictive of pathological brain lesions in boys with precocious puberty (PP) or early puberty (EP) were investigated.
METHODS
Sixty-one boys with PP or EP who had brain MRI performed were included. PP was classified into the central or peripheral type. Brain MRI findings were categorized into group I (pathological brain lesion known to cause puberty; newly diagnosed [group Ia] or previously diagnosed [group Ib]); group II (brain lesion possibly related to puberty); and group III (incidental or normal findings). Medical history, height, weight, hormone test results, and bone age were reviewed.
RESULTS
Brain lesions in groups I and II were detected in 17 of 23 boys (74%) with central PP, 9 of 30 boys (30%) with EP, and 7 of 8 boys (88%) with peripheral PP. All brain lesions in boys with peripheral PP were germ cell tumors (GCT), and 3 lesions developed later during follow-up. Group I showed earlier pubertal onset (P<0.01) and greater bone age advancement (P<0.05) than group III. Group III had lower birth weight and fewer neurological symptoms than "Ia and II" (all P<0.05).
CONCLUSION
Earlier onset of puberty, greater bone age advancement, and/or neurological symptoms suggested a greater chance of pathological brain lesions in boys with central PP or EP. All boys with peripheral PP, even those with normal initial MRI findings, should be evaluated for the emergence of GCT during follow-up.

Keyword

Male; Precocious puberty; Brain; Magnetic resonance imaging; Neoplasms

MeSH Terms

Adolescent
Birth Weight
Brain*
Follow-Up Studies
Humans
Incidence*
Magnetic Resonance Imaging*
Male
Neoplasms, Germ Cell and Embryonal
Puberty*
Puberty, Precocious

Figure

• 

  Fig. 1 Seventy-four boys with precocious puberty or early puberty who had brain magnetic resonance imaging (MRI) done were included. Thirteen boys were excluded: 5 boys with peripheral precocious puberty due to adrenal disease, testicular disease, extracranial germ cell tumor, 6 boys with history of cranial irradiation, and 2 boys with previous growth hormone treatment. In total, 61 boys were thus included in this study.

• 

  Fig. 2 Changes in beta-human chorionic gonadotropin (β-hCG) in 3 patients. (A) β-hCG levels of patient 1 were persistently high, above normal range. (B) β-hCG levels of patient 2 were normal during follow-up and increased above normal range at tumor diagnosis. (C, D) In patient 3, β-hCG level slightly decreased to 27 mIU/mL during follow-up but increased to 397 mIU/mL at 8 months. At the ninth month, β-hCG level sharply increased to 14,040 mIU/mL and pineal germ cell tumor was found at that time.

Reference

1. Carel JC, Eugster EA, Rogol A, Ghizzoni L, Palmert MR, et al. ESPE-LWPES GnRH Analogs Consensus Conference Group. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics. 2009; 123:e752–e762. PMID: 19332438.

2. Carel JC, Leger J. Clinical practice. Precocious puberty. N Engl J Med. 2008; 358:2366–2377. PMID: 18509122.

3. Carel JC, Lahlou N, Roger M, Chaussain JL. Precocious puberty and statural growth. Hum Reprod Update. 2004; 10:135–147. PMID: 15073143.

4. Chalumeau M, Hadjiathanasiou CG, Ng SM, Cassio A, Mul D, Cisternino M, et al. Selecting girls with precocious puberty for brain imaging: validation of European evidence-based diagnosis rule. J Pediatr. 2003; 143:445–450. PMID: 14571217.

5. Chalumeau M, Chemaitilly W, Trivin C, Adan L, Breart G, Brauner R. Central precocious puberty in girls: an evidence-based diagnosis tree to predict central nervous system abnormalities. Pediatrics. 2002; 109:61–67. PMID: 11773542.

6. Mogensen SS, Aksglaede L, Mouritsen A, Sorensen K, Main KM, Gideon P, et al. Pathological and incidental findings on brain MRI in a single-center study of 229 consecutive girls with early or precocious puberty. PLoS One. 2012; 7:e29829. PMID: 22253792.

7. Guillamo JS, Creange A, Kalifa C, Grill J, Rodriguez D, Doz F, et al. Prognostic factors of CNS tumours in Neurofibromatosis 1 (NF1): a retrospective study of 104 patients. Brain. 2003; 126(Pt 1):152–160. PMID: 12477702.

8. Trivin C, Couto-Silva AC, Sainte-Rose C, Chemaitilly W, Kalifa C, Doz F, et al. Presentation and evolution of organic central precocious puberty according to the type of CNS lesion. Clin Endocrinol (Oxf). 2006; 65:239–245. PMID: 16886967.

9. Moon JS, Lee SY, Nam CM, Choi JM, Choe BK, Seo JW, et al. 2007 Korean National Growth Charts: review of developmental process and an outlook. Korean J Pediatr. 2008; 51:1–25.

10. Neely EK, Wilson DM, Lee PA, Stene M, Hintz RL. Spontaneous serum gonadotropin concentrations in the evaluation of precocious puberty. J Pediatr. 1995; 127:47–52. PMID: 7608810.

11. Mul D, Hughes IA. The use of GnRH agonists in precocious puberty. Eur J Endocrinol. 2008; 159(Suppl 1):S3–S8. PMID: 19064674.

12. Chun JK, Kim JB, Yoo HW. Normative data on serum levels of IGF-I, IGFBP-3 in healthy Korean children: effect of age, sex, height, body mass index, and pubertal maturation on the serum levels. J Korean Soc Pediatr Endocrinol. 2000; 5:75–82.

13. Trifanescu R, Ansorge O, Wass JA, Grossman AB, Karavitaki N. Rathke's cleft cysts. Clin Endocrinol (Oxf). 2012; 76:151–160. PMID: 21951110.

14. Cacciari E, Zucchini S, Ambrosetto P, Tani G, Carla G, Cicognani A, et al. Empty sella in children and adolescents with possible hypothalamic-pituitary disorders. J Clin Endocrinol Metab. 1994; 78:767–771. PMID: 8126155.

15. Zacharin M. Precocious puberty in two children with neurofibromatosis type I in the absence of optic chiasmal glioma. J Pediatr. 1997; 130:155–157. PMID: 9003867.

16. Marx M, Beck JD, Grabenbauer GG, Fahlbusch R, Dorr HG. Gonadotrophin-independent puberty in a boy with a beta-HCG-secreting brain tumour. Horm Res. 2000; 54:44–48. PMID: 11182635.

17. Imel EA, Bethin KE. Etiology of gonadotropin-dependent precocious puberty. In : Pescovitz O, Walvoord EC, editors. When puberty is precocious: scientific and clinical aspect. New Jersey: Humana Press;2007. p. 331–334.

18. Schwabe J, Calaminus G, Vorhoff W, Engelbrecht V, Hauffa BP, Gobel U. Sexual precocity and recurrent beta-human chorionic gonadotropin upsurges preceding the diagnosis of a malignant mediastinal germ-cell tumor in a 9-year-old boy. Ann Oncol. 2002; 13:975–977. PMID: 12123344.

19. Crawford JR, Santi MR, Vezina G, Myseros JS, Keating RF, LaFond DA, et al. CNS germ cell tumor (CNSGCT) of childhood: presentation and delayed diagnosis. Neurology. 2007; 68:1668–1673. PMID: 17502547.

20. Rivarola , Belgorosky A, Mendilaharzu H, Vidal G. Precocious puberty in children with tumours of the suprasellar and pineal areas: organic central precocious puberty. Acta Paediatr. 2001; 90:751–756. PMID: 11519977.

21. Faizah M, Zuhanis A, Rahmah R, Raja A, Wu L, Dayang A, et al. Precocious puberty in children: A review of imaging findings. Biomed Imaging Interv J. 2012; 8:e6. PMID: 22970062.

22. Taher BM, Ajlouni HK, Hamamy HA, Shegem NS, Madanat AY, Ajlouni KM. Precocious puberty at an endocrine centre in Jordan. Eur J Clin Invest. 2004; 34:599–604. PMID: 15379758.

23. De Sanctis V, Corrias A, Rizzo V, Bertelloni S, Urso L, Galluzzi F, et al. Etiology of central precocious puberty in males: the results of the Italian Study Group for Physiopathology of Puberty. J Pediatr Endocrinol Metab. 2000; 13(Suppl 1):687–693. PMID: 10969910.

24. Rousso IH, Kourti M, Papandreou D, Tragiannidis A, Athanasiadou F. Central precocious puberty due to hypothalamic hamartoma in a 7-month-old infant girl. Eur J Pediatr. 2008; 167:583–585. PMID: 17541635.

25. Lacroix-Boudhrioua V, Linglart A, Ancel PY, Falip C, Bougneres PF, Adamsbaum C. Pineal cysts in children. Insights Imaging. 2011; 2:671–678. PMID: 22347985.

26. Dickerman RD, Stevens QE, Steide JA, Schneider SJ. Precocious puberty associated with a pineal cyst: is it disinhibition of the hypothalamic-pituitary axis? Neuro Endocrinol Lett. 2004; 25:173–175. PMID: 15349080.

27. Cnossen MH, Stam EN, Cooiman LC, Simonsz HJ, Stroink H, Oranje AP, et al. Endocrinologic disorders and optic pathway gliomas in children with neurofibromatosis type 1. Pediatrics. 1997; 100:667–670. PMID: 9310522.

28. Mohn A, Schoof E, Fahlbusch R, Wenzel D, Dorr HG. The endocrine spectrum of arachnoid cysts in childhood. Pediatr Neurosurg. 1999; 31:316–321. PMID: 10702732.

29. Huang HP, Tung YC, Tsai WY, Kuo MF, Peng SF. Arachnoid cyst with GnRH-dependent sexual precocity and growth hormone deficiency. Pediatr Neurol. 2004; 30:143–145. PMID: 14984911.

30. Karaolis-Danckert N, Buyken AE, Sonntag A, Kroke A. Birth and early life influences on the timing of puberty onset: results from the DONALD (DOrtmund Nutritional and Anthropometric Longitudinally Designed) Study. Am J Clin Nutr. 2009; 90:1559–1565. PMID: 19828713.