Routine screening by brain magnetic resonance imaging is not indicated in every girl with onset of puberty between the ages of 6 and 8

Context: It is still controversial whether all girls with central precocious puberty (CPP) should undergo brain MRI for unveiling intracranial pathology. Objectives: To determine the prevalence and type of intracranial lesions in otherwise normal girls with central precocious puberty (idiopathic CPP) and to identify the clinical and biochemical predictors of brain abnormalities. Design and Setting: Retrospective study conducted at the Endocrine Unit of "Bambino Gesù" Children's Hospital, Rome, Italy, from 1990 to 2012. Patients: 182 girls were consecutively diagnosed with CPP. All girls underwent thorough endocrine assessment and brain MRI with detailed examination of hypothalamic-pituitary area. None of them had history of neurological diseases, endocrine disorders, neurofibromatosis or other genetic syndromes, previous hormonal therapies. Main Outcome Measure: Prevalence of brain abnormalities at MRI scan. Results: Brain MRI showed no alteration in 157 (86%), incidentalomas of the hypothalamic-pituitary area unrelated to CPP in 19 (11%), and hamartomas in 6 girls (3%). Girls with hamartomas were younger than 6 years, had significantly higher mean baseline and stimulated LH values (P<0.001), LH/FSH ratio (P<0.001), serum 17-β-estradiol levels (P<0.001), and uterine length (P<0.05). However, all the parameters overlapped extensively in girls with or without cerebral alterations. Conclusions: Our data cast doubt on the need of routine screening by brain MRI in girls with idiopathic CPP older than 6 years. Evidence-based criteria to drive clinical decision making about the use of MRI are lacking.