Clinical and Etiological Evaluation of Male Patients with Central Precocious Puberty: Findings from a Single-Center Cohort.

Abstract

Objective: Central precocious puberty (CPP) is considerably less common in boys than in girls, and its underlying causes are more heterogeneous. Although earlier reports emphasized a high frequency of central nervous system (CNS) lesions in affected boys, recent data suggest a rising proportion of idiopathic cases.

Methods: In this retrospective cross-sectional study, medical records of 46 boys diagnosed with CPP between 2015 and 2025 were reviewed. Clinical data included age at diagnosis, anthropometry, pubertal stage, bone age (BA), hormonal measurements, and brain magnetic resonance imaging (MRI) findings. Patients were categorized as idiopathic or neurogenic CPP according to MRI results. Group comparisons were performed using appropriate statistical tests, with P < .05 considered significant.

Results: The mean age at diagnosis was 8.17 ± 1.73 years, and nearly half of the patients were referred for non-pubertal concerns. Magnetic resonance imaging (MRI) was normal in 68% of cases, while 32% had neurogenic CPP. The most frequent lesions were hypoxic-ischemic encephalopathy sequelae (20%), partial empty sella (20%), hypothalamic hamartoma (13%), and Rathke's cleft cysts (13%). No significant differences were found between idiopathic and neurogenic groups regarding basal luteinising hormone (LH), peak LH, testosterone levels, BA advancement, or pubertal stage at presentation.

Conclusion: In this cohort, idiopathic CPP constituted the majority of cases in boys, supporting recent epidemiological trends. Clinical and hormonal parameters did not reliably distinguish neurogenic from idiopathic CPP, underscoring the continued importance of cranial MRI in evaluating boys with CPP. Larger, multi center studies with long-term follow-up are needed to refine risk stratification and imaging indications in this population.