Clinical_Rounds_in_Endocrinology_Volume_II_-_Pediatric_Endocrinology

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addition, girls with age of onset of precocity <6 years, patients with coexisting

neurological manifestations (e.g., gelastic seizures, visual impairment), and

those with rapid progression of puberty (progression from one stage to the next

within 3–6 months) are also likely to have a CNS pathology as the cause of

precocity. A pituitary height >6 mm with convex upper border suggests the

presence of GDPP of any etiology. The common CNS lesions associated with

precocious puberty include hypothalamic hamartoma, optic glioma associated

with NF1, and suprasellar lesions (e.g., germinoma, pilocytic astrocytoma,

arachnoid cyst, and rarely craniopharyngioma) (Figs. 6.15, 6.16, and 6.17).

a b

d

c

Fig. 6.15 (a) A 5-year-old boy with GDPP. (b) External genitalia showing Tanner pubic hair
stage P 4 and bilateral testicular volume 10 ml. (c, d) Coronal T1 pre- and post-contrast MR show-
ing a complex solid cystic suprasellar lesion (red arrows). Histopathology of tumor tissue was
consistent with pilocytic astrocytoma

6 Precocious Puberty