title: Routine screening by brain magnetic resonance imaging is not indicated in every girl with onset of puberty between the ages of 6 and 8 years.
abstract: BACKGROUND
  It is still controversial whether all girls with central precocious puberty (CPP) should undergo brain magnetic resonance imaging (MRI) for unveiling intracranial pathology.
  
  
  OBJECTIVE
  The objectives of the study were 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.
  
  
  METHODS
  This was a retrospective study conducted at the Endocrine Unit of "Bambino Gesù" Children's Hospital (Rome, Italy) from 1990 to 2012.
  
  
  METHODS
  One hundred eighty-two girls were consecutively diagnosed with CPP. All girls underwent a thorough endocrine assessment and brain MRI with a detailed examination of the hypothalamic-pituitary area. None of them had a history of neurological diseases, endocrine disorders, neurofibromatosis or other genetic syndromes, or previous hormonal therapies.
  
  
  METHODS
  Prevalence of brain abnormalities at MRI scan was measured.
  
  
  RESULTS
  Brain MRI showed no alteration in 157 (86%), incidentalomas of the hypothalamic-pituitary area unrelated to CPP in 19 (11%), and hamartomas in six girls (3%). Girls with hamartomas were younger than 6 years and had significantly higher mean baseline and stimulated LH values (P < .001), LH to FSH ratio (P < .001), serum 17β-estradiol levels (P < .001), and uterine length (P < .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.
authors.affiliation: Dipartimento Pediatrico Universitario Ospedaliero, "Bambino Gesù" Children's Hospital-Tor Vergata University (S.P., P.A., G.S., S.C.), and Endocrinology and Diabetes Unit (M.C.), "Bambino Gesù" Children's Hospital, 00165 Rome, Italy; and Department of Women's and Children's Health (S.C.), Karolinska Institutet, SE-171 77 Stockholm, Sweden.
authors.forename: Stefania
authors.initials: S
authors.lastname: Pedicelli
authors.forename: Paola
authors.initials: P
authors.lastname: Alessio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Scirè
authors.forename: Marco
authors.initials: M
authors.lastname: Cappa
authors.forename: Stefano
authors.initials: S
authors.lastname: Cianfarani
mesh_terms: D000365:Age Determination by Skeleton; D001921:Brain / Q000473:pathology*; D001927:Brain Diseases / Q000453:epidemiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D007031:Hypothalamus / Q000473:pathology; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D010902:Pituitary Gland / Q000473:pathology; D015995:Prevalence; D011629:Puberty, Precocious / Q000175:diagnosis* / Q000473:pathology*; D012189:Retrospective Studies
chemical_list: D012739:Gonadal Steroid Hormones