What is the role of head MRI in the workup of precocious puberty?

Updated: Nov 30, 2020
  • Author: Paul B Kaplowitz, MD, PhD; Chief Editor: Robert P Hoffman, MD  more...
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Many authors have recommended that a brain MRI be performed to look for a tumor or a hamartoma in any child after hormonal studies indicate a diagnosis of CPP. [43] However, subsequent studies have suggested that the finding of tumors or hamartomas in girls between the ages of 6 an 8 years is very low, while incidental findings are more common. [2]  Thus, many now advise limiting such studies to girls younger than age 6 years at the onset of puberty, unless there are signs and symptoms suggestive of a CNS tumor or mass. [44]  In such cases, consultation is suggested with a pediatric endocrinologist who can order the study, if indicated, and ask the radiologist to obtain a high-resolution study that focuses on the hypothalamic-pituitary area.

For boys younger than 9 years, the incidence of CNS findings is much higher than in girls, and MRI should be part of the evaluation.

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