MON-061 A Case of Central Precocious Puberty Patient with Arnold Chiari Malformation, Type I
Bibliographic record
Abstract
Abstract Central precocious puberty (CPP) is caused by early activation of Hypothalamo-Hypophyseal-Gonal (H-P-G) axis. Although the cause of CPP is idiopathic in most cases, small portions of CPP are caused by intracranial lesion such as hypothalamic hamartomas, postencephalitic scars, tubercular meningitis, head trauma, hydrocephalus, tuberous sclerosis, arachnoid cyst, etc. Type I Chiari malformation is a disorder characterized by a displacement of the cerebellar tonsils through the foramen magnum into the upper cervical spinal canal with various neurologic symptom. There have been some reported cases of Arnold-Chiari type I malformations with CPP, however this association is not yet completely understood. We would like to introduce a case of girl experiencing Arnold Chiari type I malformation as well as CPP, who presented with progressive breast budding and acceleration of growth. A 8-year-old girl was presented with 6month history of breast budding and acceleration of growth (5cm/7month). Her family history demonstrated that her mother had been treated with prolactinoma and experienced early menarche. On physical examination, she showed Tanner stage 2(B2, P1). She did not exhibit any neurological signs or symptoms. Thyroid gland was not enlarged and No abnormal skin pigmentation or bony abnormalities were identified. Her height was 124.9cm (37th percentile), weight was 22.4kg (14th percentile), while midparental height was calculated to be 159cm (father: 174cm, mother: 157cm). Her bone age was assessed to be 10 years of age. Luteinizing hormone(LH) showed pubertal response (peak LH: 9.9IU/L) in Luteinizing Hormone Releasing Hormone (LHRH) stimulation test. The abdominopelvic US revealed pubertal response of uterus(length 4.1cm, endometrial echogenicity) without any other abnormality. We performed brain Magnetic Resonance Imaging(MRI) for rule out intracranial lesion, which showed Arnold-Chiari type 1 malformation (downward displacement of the cerebellar tonsil by 6 mm). Following diagnosis, Her parents wanted further neurologic evaluation and treatment in Canada, beacause she was Canadian. In conclusion, Arnold-Chiari type 1 malformation can be a possible cause of CPP without neurological symptoms in children, more cases are needed to clarify the relationship and evaluate reasonable causes of Arnold-Chiari type 1 malformation in the brain, especially in young patients with precocious puberty.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".