The classic approach to the work-up of central precocious puberty (CPP) has been to recommend a brain imaging study to exclude an anatomic cause for the early onset of puberty, such as a tumor (most commonly a glioma or an astrocytoma), a hamartoma, or a subarachnoid cyst. Given the relative infrequency of CPP in boys and the relatively high reported incidence of abnormal findings, few would argue with ordering a magnetic resonance imaging (MRI) or a computed tomography scan as part of the evaluation for boys. The situation for early-maturing girls is much less clear. Many authors have advocated brain imaging for all girls meeting the criteria for CPP (age of onset <8 years plus evidence of activation of the hypothalamic-pituitary-gonadal axis), although it was recognized that in the majority of cases (80% to >90%, depending on the study), the study would be normal. Others have recommended imaging...

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