Idiopathic central precocious puberty on the rise in boys

By Eleanor McDermid, Senior medwireNews Reporter

About three-quarters of cases of central precocious puberty (CPP) in boys have no identifiable cause, say researchers.

Ayfer Alikasifoglu (Hacettepe University, Ankara, Turkey) and colleagues assessed 100 boys, aged between 9 months and 10.5 years, who were diagnosed with CPP between 2003 and 2014.

Just 26% of these cases were found to have an underlying central nervous system (CNS) abnormality, which the team says is “one of the lowest rates in the literature”.

The number of cases with CNS lesions diagnosed remained stable, at six or seven per 2-year period, but the overall number of CPP cases rose, due to an increasing proportion of idiopathic cases per 2-year period increased over time, from 33.3% during 2003 to 2005, rising as high as 81.6% in more recent time periods.

The researchers note that they included all cases with CNS abnormalities regardless of whether the lesion or CPP was diagnosed first, thus providing an accurate estimate of the proportion of CPP cases with an underlying organic cause.

“It should always be kept in mind that there is a significant amount of patients with a CNS lesion who are diagnosed with CPP during follow-up”, they write in Hormone Research in Paediatrics.

Spacing-occupying lesions accounted for 20 of the 26 CNS abnormalities detected, and the remaining six were developmental abnormalities.

The likelihood of identifying a CNS lesion varied with age; 60% of children younger than 7 years had an underlying CNS lesion, compared with just 8% of older children. They also had a more advanced bone age than children with idiopathic CPP. Their basal testosterone levels were significantly higher than those of the idiopathic CPP cases, as were their peak luteinizing hormone levels.

“When a boy is diagnosed with CPP above the age of 7 years, the odds of detecting an underlying CNS pathology are very low, and these cases are mostly idiopathic”, say the researchers.

They suggest that, as with girls, increased weight gain during childhood may increase the risk of boys experiencing CPP. But they also note that increased awareness of CPP among patients and physicians could have contributed to the increased prevalence of idiopathic cases.

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