New Study Examines Neurogenic Early Puberty, Confirms Diagnostic Tools
Recent studies in the United States and other countries suggest that girls are undergoing puberty at a younger age and have higher rates of central precocious puberty (CPP) than in the past. It is unknown if this secular trend extends to boys with CPP, who sit at the extreme end of the pubertal spectrum, and if neuroimaging should remain a standard diagnostic tool. A new study led by physicians and researchers at Hasbro Children’s Hospital sought to examine cases of CPP in male pediatric patients and the underlying reasons for the condition to determine the most appropriate and effective diagnostic tool.
The study was designed as a retrospective chart review of all male pediatric patients with CPP, who were seen by endocrinologists at a US pediatric hospital between the years 2001 and 2010. The results of the study identified 50 boys with CPP who experienced pubertal onset at an average age of 7.31 years. However, many of these boys did not present until nearly one year thereafter, by which time 30 percent were mid-to-late pubertal. The subjects were predominantly non-Hispanic white and 64 percent were overweight or obese.
CPP can be neurogenic, caused by an identifiable underlying central nervous system disturbance, or can be idiopathic, with no discernible abnormality. In this study, 64 percent of the boys had neurogenic CPP (CNS-CPP) with neurofibromatosis type I as the most common diagnosis. A diagnosis of CPP led to the discovery of a neurogenic lesion in only 3 out of 32 of the CNS-CPP cases. The remaining boys with idiopathic CPP were indistinguishable from those with CNS-CPP aside from four boys who showed a family history of precocious puberty. Notably, there was no change in the incidence of male CPP after accounting for the increase in clinic volume during this time period.
The results of the study showed that of 50 boys with CPP, most cases were neurogenic, consistent with older literature. Several idiopathic cases had a family history of precocious puberty, but were otherwise indistinguishable from CNS-CPP cases. Neuroimaging remains a critical and effective diagnostic tool for identifying cases of CPP. In addition, there was no evidence found of an increase in the prevalence of male CPP.