Prevalence and effects on outcomes of intracranial tumors and structural alterations in children with central precocious puberty and early and fast puberty.

OBJECTIVE: To investigate intracranial lesion prevalence in children with central precocious puberty (CPP) and early and fast puberty (EFP), and assess impacts on progression and GnRHa response. METHODS: This retrospective study included 1,087 CPP/EFP patients (2011-2023) who underwent brain MRI. Patients were stratified by MRI findings: no lesion, other (incidental) lesions, and pathogenic lesions (hypothalamic hamartoma/glioma). Clinical, hormonal, bone age, and growth parameters were compared. GnRHa dosing and therapeutic responses were evaluated. RESULTS: Intracranial lesions were detected in 14.5% of girls and 19.6% of boys (P = 0.089). Detection was age-dependent: children under specific thresholds (girls <6y, boys <7y) had significantly higher rates than older peers (33.7% vs. 12.1%, P <0.001; 53.8% vs. 16.9%, P = 0.004). Pathogenic lesions (n=26) occurred exclusively in CPP, linked to earlier puberty onset (girls: 1.9y; boys: 1.0y) and elevated luteinizing hormone (LH) levels (P<0.05). Among treated girls (n=312), those with pathogenic lesions required higher 6-month GnRHa doses (P = 0.025) and exhibited faster initial growth velocity (P = 0.007), despite similar hormone suppression and 1-year height SDS changes. Incidental lesions (e.g., Rathke's cysts) did not alter progression or treatment response. CONCLUSION: Routine MRI is warranted for younger CPP children (girls <6y, boys <7y) due to high pathogenic lesion rates. Conversely, older CPP and all EFP cases show low pathogenic prevalence, questioning universal MRI screening. While incidental lesions require no management alteration, CPP with hypothalamic hamartoma/glioma presents with earlier onset and heightened axis activation, necessitating higher GnRHa doses.