Pineal cysts may promote pubertal development in girls with central precocious puberty: a single-center study from China.
Level 3 - non-randomized controlled study
Retrospective matched comparative cohort study
PubMed 38405141 · doi:10.3389/fendo.2024.1323947
What was done
This retrospective, single-center study reviewed brain/pituitary MRI scans from 23,245 girls aged 3 to 10 years evaluated between 2019 and 2022 at a pediatric hospital in China. Researchers compared the prevalence of pineal cysts between girls with central precocious puberty (CPP, n = 4,099) and those without CPP (n = 19,146). Girls with CPP and pineal cysts were 1:1 matched by age and BMI to CPP girls without cysts to compare clinical, endocrine (estradiol, peak LH, peak LH/FSH ratio), and pelvic ultrasound features. Subgroup analyses were performed across three cyst size categories (≤5 mm, 5.1–9.9 mm, and ≥10 mm), and imaging follow-up was evaluated in a subset of 19 patients.
What was found
The pineal cyst detection rate was 3.6% (837/23,245) overall, and significantly higher in girls with CPP (6.4%, 262/4,099) compared to those without CPP (3.0%, 575/19,146). In the matched comparison, the cyst group showed significantly elevated estradiol levels, peak LH levels, peak LH/FSH ratios, uterine body length, and cervix length compared to the non-cyst group (all P < 0.001). Increasing cyst size was associated with progressive rises in LH peak, peak LH/FSH ratio, uterine body length, and cervical length (P < 0.01), along with higher estradiol levels and left ovarian volume (P < 0.05). Among 19 girls with follow-up imaging, 26.3% (5/19) showed cyst enlargement.
Why it matters
Pineal cysts are traditionally considered incidental, benign findings, but these results indicate they may not be entirely inert in the setting of early puberty. Larger pineal cysts (>5 mm) in particular correlate with accelerated pubertal progression and elevated gonadotropin levels, suggesting they could contribute to pubertal activation in a subset of girls with CPP.
Limits
The study is retrospective and conducted at a single tertiary hospital, creating potential referral and selection bias. Causal mechanisms linking pineal cysts to hypothalamic-pituitary-gonadal axis activation were not established, and melatonin levels were not reported. Long-term longitudinal follow-up was limited to a very small subset (n = 19) of patients.
Cited by
- partial Pineal cysts can cause precocious puberty in children around eight or nine years of age.