■松果体囊肿长期以来被认为是良性颅内变异。然而,在我们的临床实践中,已经观察到,一些患有松果体囊肿的中枢性性早熟(CPP)儿童在青春期发育过程中经历了快速进展.近年来,在女孩中,CPP的患病率显着增加,导致在松果体囊肿儿童中更多的CPP诊断。尽管如此,关于松果体囊肿是否作为CPP的有机因素之一对CPP有贡献,目前尚无共识.本研究旨在分析CPP患儿松果体囊肿的临床特点,探讨松果体囊肿对青春期发育的潜在影响。
这项单中心研究回顾性分析了2019年至2022年在郑州大学附属儿童医院接受头部/垂体磁共振成像的3至10岁女孩的临床数据。该研究根据系统疾病分类对松果体囊肿的检出率进行了分类,并比较了诊断为CPP的女孩和没有CPP的女孩之间的囊肿检出率。随后,检查了CPP诊断的松果体囊肿女孩。在符合研究标准的CPP诊断女孩中,那些有松果体囊肿的人形成了囊肿组,而没有囊肿的患者根据年龄和体重指数以1:1的比例进行匹配,以形成非囊肿组。进行比较分析以评估这两组之间的临床特征。根据囊肿大小(≤5毫米,5.1-9.9mm,和≥10mm)以调查这些亚组之间临床特征的潜在差异。该研究涉及对诊断为CPP的女孩的临床数据的分析,并包括影像学随访,以探讨松果体囊肿随时间的进展。
■在23,245名接受头部/垂体磁共振成像扫描的女孩中,松果体囊肿检出率为3.6%(837/23,245),大多数病例与内分泌疾病相关。CPP患者松果体囊肿检出率为6.4%(262/4099),显著高于无CPP患者的3.0%(575/19,146)。与非囊肿组相比,囊肿组雌二醇水平显著增加,黄体生成素(LH)峰值水平,峰值LH/卵泡刺激素(FSH)比率,子宫体长,宫颈长度(P<0.001)。随着囊肿大小的增加,LH峰值有显著上升,LH/FSH峰值比值,子宫体长,宫颈长度(P<0.01)。雌二醇水平和左卵巢体积也呈增加趋势(P<0.05)。在接受随访成像的女孩中,26.3%(5/19)囊肿大小增大。
■松果体囊肿在CPP患儿中比较常见。它们可能会影响青春期发育过程,与更快的青春期发育相关的较大的囊肿。因此,作者假设松果体囊肿在某些情况下可能引发CPP,特别是当囊肿大于5毫米时,如我们的数据所示。
Pineal cysts have long been considered a benign intracranial variation. However, in our clinical practice, it has been observed that some children with central precocious puberty (CPP) who have pineal cysts experience rapid progression in adolescent development. In recent years, there has been a significant increase in the prevalence of CPP in girls, leading to more diagnoses of CPP among children with pineal cysts. Despite this, there is no consensus regarding whether pineal cysts contribute to CPP as one of its organic factors. This study aimed to analyze the clinical characteristics of pineal cysts in children with CPP and explore the potential effects of pineal cysts on puberty development.
This single-center study retrospectively analyzed clinical data from girls aged 3 to 10 years who underwent head/pituitary magnetic resonance imaging at the Children\'s Hospital Affiliated to Zhengzhou University between 2019 and 2022. The study categorized the detection rates of pineal cysts based on systematic disease classification and compared the rates of cyst detection between girls diagnosed with CPP and those without CPP. Subsequently, CPP-diagnosed girls with pineal cysts were examined. Among CPP-diagnosed girls meeting the study\'s criteria, those with pineal cysts formed the \'cyst group,\' while those without cysts were matched in a 1:1 ratio based on age and body mass index to form the \'non-cyst group.\' Comparative analyses were conducted to assess the clinical characteristics between these two groups. CPP-diagnosed girls with cysts were further subdivided into three groups according to cyst size (≤5 mm, 5.1-9.9 mm, and ≥10 mm) to investigate potential differences in clinical characteristics among these subgroups. The study involved an analysis of clinical data from girls diagnosed with CPP and included imaging follow-ups to explore the progression of pineal cysts over time.
Among the 23,245 girls who underwent head/pituitary magnetic resonance imaging scans, the detection rate of pineal cysts was 3.6% (837/23,245), with most cases being associated with endocrine diseases. The detection rate of pineal cysts in CPP patients was 6.4% (262/4099), which was significantly higher than the 3.0% (575/19,146) in patients without CPP. In comparison to the non-cyst group, the cyst group exhibited statistically significant increases in estradiol levels, peak luteinizing hormone (LH) levels, peak LH/follicle-stimulating hormone (FSH) ratios, uterine body length, and cervix length (P < 0.001). As cyst size increased, there were significant rises in LH peak, peak LH/FSH ratio, uterine body length, and cervical length (P < 0.01). Estradiol levels and left ovarian volume also showed an increasing trend (P < 0.05). Among girls who underwent follow-up imaging, 26.3% (5/19) exhibited an increase in cyst size.
Pineal cysts are relatively common in children with CPP. They may affect the pubertal development process, with larger cysts correlating to faster pubertal development. Therefore, the authors hypothesize that pineal cysts may trigger CPP in some cases, especially when the cysts are larger than 5 mm in size, as indicated by our data.