Cranial MRI in Girls With Central Precocious Puberty: Clinical Characteristics and Predictors of Abnormal Findings.

Objectives: To describe the clinical profile of girls with central precocious puberty (CPP) and determine the factors associated with abnormal cranial magnetic resonance imaging (MRI) findings. Methods: This retrospective study included girls aged 8 years or younger with a diagnosis of CPP who received care at King Abdullah Specialized Children's Hospital in Riyadh, Kingdom of Saudi Arabia, between 2015 and 2023. Data on clinical presentation, biochemical results, imaging findings, and treatment were obtained from medical records. Logistic regression analysis was performed to determine variables associated with MRI utilization and the occurrence of abnormal MRI findings. Results: The cohort comprised 70 girls with CPP. The median age at breast development was 7.12 years, and pubertal onset occurred at ≥6 years in 84.3% of patients. Cranial MRI was obtained in 43 patients (61.4%), and abnormal findings were identified in 17 patients (24.3%). Pituitary gland enlargement (n = 6) and hypothalamic hamartoma (n = 4) were the most frequent abnormalities. Girls with a bone age-to-chronological age ratio <1 year had lower odds of undergoing MRI (OR = 0.18, Conclusion: Abnormal cranial MRI findings were identified in nearly one-quarter of girls with CPP. Higher BMI z-scores were associated with abnormal MRI findings, whereas age at puberty onset and other clinical variables did not reliably predict intracranial abnormalities.