Central precocious puberty in a toddler with hypothalamic hamartoma

Banu Turhan; Gönül Büyükyılmaz; Mehmet Boyraz

doi:10.1515/jpem-2024-0273

Article

Central precocious puberty in a toddler with hypothalamic hamartoma

Banu Turhan , Gönül Büyükyılmaz and Mehmet Boyraz

Published/Copyright: December 24, 2024

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 38 Issue 2

Abstract

Objectives

Hypothalamic hamartoma (HH) is a rare condition that causes epilepsy and central precocious puberty (CPP) at an early age. In this report, we describe a child with CPP secondary to HH and discuss the current literature.

Case presentation

A 26-month-old girl was brought to our hospital for evaluation of breast enlargement. Her parents were first-degree relatives. Her breast development was categorized as Tanner stage 3, and her bone age was 7 years/4 months. Laboratory investigations were consistent with CPP. Brain magnetic resonance imaging (MRI) revealed a smooth, spherical lesion in the hypothalamus, located in the tuber cinereum and measuring 11 × 9 × 10 mm. The lesion was identified as a HH. The patient was started on gonadotropin-releasing hormone analogue therapy, specifically 200 μg/kg/month of leuprolide acetate (3.75 mg depot) administered intramuscularly every 28 days. During the 2-year follow-up, her breast development remained at Tanner stage 3, and she did not develop axillary or pubic hair. Her bone age was 7 years/6 months (chronological age; 4 years/2 months). 2-year follow-up MRI showed no change in the size or contours of the HH compared with the initial diagnosis. No side effects from the medical treatment were observed during the follow-up period.

Conclusions

In patients under the age of 4 years showing signs of CPP, HH should be considered as diagnosis. All patients receiving medical treatment should be closely monitored.

Keywords: hypothalamic hamartoma; central precocious puberty; toddler

Corresponding author: Banu Turhan, MD, Specialist, Pediatric Endocrinology Clinic, Bilkent City Hospital, Üniversiteler, Rıfat Börekçi, 06800 Çankaya, Ankara, Türkiye, E-mail: benguulkuturhan@yahoo.com

Research ethics: Not applicable.
Informed consent: Informed consent was obtained from the patient included in this case report.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Use of Large Language Models, AI and Machine Learning Tools: None declared.
Conflict of interest: Authors state no conflict of interest.
Research funding: None declared.
Data availability: Not applicable.

References

1. Latronico, AC, Brito, VN, Carel, JC. Causes, diagnosis, and treatment of central precocious puberty. Lancet Diabetes Endocrinol 2016;4:265–74. https://doi.org/10.1016/S2213-8587(15)00380-0.Search in Google Scholar PubMed

2. Greiner, H, Leach, JL, Lee, KH, Krueger, DA. Anti-NMDA receptor encephalitis presenting with imaging findings and clinical features mimicking rasmussen syndrome. Seizure 2011;20:266–70. https://doi.org/10.1016/j.seizure.2010.11.013.Search in Google Scholar PubMed

3. Suh, J, Choi, Y, Oh, JS, Song, K, Choi, HS, Kwon, A, et al.. Management of central precocious puberty in children with hypothalamic hamartoma. Children 2021;8:711. https://doi.org/10.3390/children8080711.Search in Google Scholar PubMed PubMed Central

4. Freeman, JL, Coleman, LT, Wellard, RM, Kean, MJ, Rosenfeld, JV, Jackson, GD, et al.. MR imaging and spectroscopic study of epileptogenic hypothalamic hamartomas: analysis of 72 cases. AJNR Am J Neuroradiol 2004;25:450–62.Search in Google Scholar

5. Ng, YT, Rekate, HL, Prenger, EC, Chung, SS, Feiz-Erfan, I, Wang, NC, et al.. Transcallosal resection of hypothalamic hamartoma for intractable epilepsy. Epilepsia 2006;47:1192–202. https://doi.org/10.1111/j.1528-1167.2006.00516.x.Search in Google Scholar PubMed

6. Bernal, B, Grossman, S, Gonzalez, R, Altman, N. FMRI under sedation: what is the best choice in children? J Clin Med Res 2012;4:363–70. https://doi.org/10.4021/jocmr1047w.Search in Google Scholar PubMed PubMed Central

7. Corbet, BG, Liang, H, Lancaster, R, Cross, JH, Tisdall, M, Varadkar, S, et al.. Neuropsychiatric profile of paediatric hypothalamic hamartoma: systematic review and case series. Dev Med Child Neurol 2019;61:1377–85. https://doi.org/10.1111/dmcn.14241.Search in Google Scholar PubMed

8. Neville, KA, Walker, JL. Precocious pubarche is associated with SGA, prematurity, weight gain, and obesity. Arch Dis Child 2005;90:258–61. https://doi.org/10.1136/adc.2004.053959.Search in Google Scholar PubMed PubMed Central

9. Brito, PC, Lopes, V, Antunes, E, Alves, M, Gonçalves, I, Matos, AC. Hypoglycemia in a non-diabetic patient and the side effects of diazoxide use. Cureus 2023;15:e36804. https://doi.org/10.7759/cureus.36804.Search in Google Scholar PubMed PubMed Central

10. Guaraldi, F, Beccuti, G, Gori, D, Ghizzoni, L. Management of endocrine disease: long-term outcomes of the treatment of central precocious puberty. Eur J Endocrinol 2016;174:R79–87. https://doi.org/10.1530/EJE-15-0590.Search in Google Scholar PubMed

Received: 2024-05-10

Accepted: 2024-12-03

Published Online: 2024-12-24

Published in Print: 2025-02-25

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Articles in the same Issue

https://doi.org/10.1515/jpem-2024-0273

Keywords for this article

hypothalamic hamartoma; central precocious puberty; toddler