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Girls with Gonadotrophin-dependent Precocious Puberty: Do They All Deserve Neuroimaging?

For many decades, it has been appreciated that gonadotropin (Gn)-dependent precocious puberty (PP) in boys is likely to result from an occult intracranial tumour, whereas girls usually have an 1 ") 'idiopathic' aetiology. However, recent studies ' have shown a significant occurrence of intracranial lesions in girls with central PP (CPP), suggesting the necessity of neuroimaging for both sexes. Hamartomas situated in the hypothalamic region are considered the most common cause of 'organic' CPP in girls. In addition, optic nerve gliomas (often associated with neurofibromatosis type I), astrocytomas and germinomas (secreting hCG in boys) have been associated with the development of CPP whereas craniopharyngiomas, Rathke's cysts, germinomas (in girls) and Langerhans cell histiocytosis are only rarely implicated. Ideally, all girls with Gn-dependent PP, confirmed by LHRH test, should be investigated with a brain MRI scan. However, some authors have attempted to define which girls with Gndependent PP should undergo neuroimaging, based on clinical and laboratory findings which would indicate an 'organic' origin. In 1983, Cacciari et al. showed that there is a tendency for organic CPP to have an onset at a much younger age and to have higher serum LH concentrations, the latter not being associated with ovulation. Chemaitilly et al} confirmed that LH, FSH and LH/FSH peaks ratio after stimulation were higher in organic CPP. The latter was not confirmed in the present study of Ng