Paediatric ImagingPrecocious puberty
a condition characterized by premature development of secondary sexual characteristics and gonadal development prior to 8 years of age in girls and 9 years of age in boys. Precocious puberty is classified into true and pseudotypes. True precocious puberty is always isosexual and includes early development of secondary sexual characteristics and an increase in size and activity of the gonads. In pseudoprecocious puberty the secondary sex characteristics may be iso- or heterosexual but the gonads do not mature.
Causes include central nervous system cysts and tumours of the pituitary gland, hypothalamus or pineal gland, hydrocephalus, post encephalitic scarring, ovarian tumours, feminizing adrenal cortical tumours, adrenal carcinoma, exogenous sources of oestrogen and the McCune Albright syndrome in girls (Fig.1) and in boys, the same lesions as well as adrenogenital syndrome, Leydig cell tumours and a gonadotrophin producing hepatoma. Radiological evaluation of precocious puberty includes abdominal and pelvic ultrasound, radiography of hand and wrist for assessment of skeletal maturation and MRI of the brain and pituitary gland when clinical and biochemical signs suggest a central lesion. See presacral mass, McCune Albright syndrome, adrenal carcinoma
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A 3-year-old girl with clinical presentation of apparent haematuria. (a) Ultrasound of the genitourinary tract showed an enlarged uterus.
(b) Lateral skull radiograph demonstrates sclerosis of the sphenoidal bone due to fibrous dysplasia.
(c) MRI of the head which demonstrates thickening of the diploic space within the roof of the orbit and the sphenoidal bone due to fibrous dysplasia. This child also had lesions in her occipital bone and in her pelvis.
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Precocious puberty, Fig.1 (a) | | Precocious puberty, Fig.1 (b) | | Precocious puberty, Fig.1 (c) |