Prevalence of organic central precocious puberty in males: criteria for a high index of suspicion.

Background: a high prevalence (40-75%) of organic brain lesions in boys with central precocious puberty (CPP) has been reported.

Objectives: to evaluate the causes of CPP in a large cohort of males and to identify possible predictive factors for organic brain lesions in males.

Design: an observational study was conducted in 102 otherwise healthy boys with CPP diagnosed from 1998 to 2023 in a single tertiary center.

Methods: all boys underwent a thorough clinical, endocrine and neuroimaging assessment with a detailed evaluation of the pituitary region.

Results: organic CPP were found in only 8/102 children (7.8%). Children with brain tumors were younger than 8 years, had no family history positive for precocious puberty and maternal menarche occurred at an age significantly more advanced than in children with idiopathic CPP. Headache was reported at diagnosis in 7/8 children with brain tumors. A progressive increase in the occurrence of idiopathic CPP in males has been observed in the last two decades with a peak of new diagnoses during the pandemic lockdown.

Conclusions: our findings indicate that the prevalence of pathological brain lesions in boys with CPP is considerably lower than previously reported thus making the diagnosis less alarming. Age younger than eight years, presence of neurological symptoms, family history negative for precocious puberty in first degree relatives and age of maternal menarche older than 11 years raise suspicion of organic CPP and should lead to prompt neuroimaging.