When Puberty Comes Too Soon: Central Precocious Puberty with Pituitary Microadenoma and Pineal Cyst
https://doi.org/10.15605/jafes.041.S1
- Author:
Fawza Nabila Faudzi
1
;
Asmalaini Mohamad
1
;
Nalini M. Selveindran
2
Author Information
1. Paediatric Department, Hospital Sultanah Nur Zahirah
2. Paediatric Department, Hospital Putrajaya
- Publication Type:Journal Article
- MeSH:
Central Nervous System Cysts;
Puberty
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):145-146
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Central precocious puberty (CPP) is defined as premature
activation of the hypothalamic-pituitary-gonadal axis,
resulting in the development of secondary sexual
characteristics before 8 years of age in girls. While most
cases are idiopathic, intracranial pathologies such as
pituitary lesions may cause CPP. Early identification is
essential to optimize outcomes and minimize psychosocial
impact. We report a case of CPP associated with pituitary
microadenoma and pineal cyst from the Paediatric
Department, Hospital Sultanah Nur Zahirah.
Case:A 4-year-old female presented with bilateral breast enlargement, with ultrasonography showing normal fibroglandular
tissue. Breast development was noted since 3 months of
age, with whitish vaginal discharge from 2 years. She
demonstrated accelerated growth, with height and weight
above the 95th centile. There were no features suggestive
of peripheral causes or raised intracranial pressure.
Examination revealed Tanner stage A1B3P2. Bone age was
markedly advanced (11 years vs. chronological age 4 years). Hormonal evaluation showed elevated LH (3.28 IU/L) and
follicle-stimulating hormone (4.79 IU/L), consistent with
CPP. MRI demonstrated focal delayed enhancement in
the posterolateral pituitary suggestive of microadenoma,
and an incidental pineal cyst without complex features.
Ophthalmological assessment was normal. Neurosurgical
evaluation advised conservative management with annual
imaging surveillance. Intramuscular Triptorelin was
initiated at 4 years 1 month. Follow-up showed regression
of pubertal progression, resolution of vaginal discharge,
and reduced growth velocity to 6 cm/year.
Conclusion:This case highlights the importance of thorough evaluation
in CPP to identify underlying intracranial pathology.
Early initiation of gonadotropin-releasing hormone
analog therapy effectively halts pubertal progression and
preserves growth potential.
- Full text:2026081017225703274EP_P022.pdf
