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The mechanism for CPP associated with HH may relate to ectopic generation and pulsatile release of gonadotropin\u2010releasing hormone (GnRH) from the HH, but this remains an unproven hypothesis. Possible regulators of GnRH release that are intrinsic to HH tissue include the following: (1) glial factors (such as transforming growth factor \u03b1[TGF\u03b1) and (2) \u03b3\u2010aminobutyric acid (GABA)\u2013mediated excitation. Both are known to be present in surgically\u2010resected HH tissue, but are present in patients with and without a history of CPP, suggesting the possibility that symptoms related to HH are directly associated with the region of anatomic attachment of the HH to the hypothalamus, which determines functional network connections, rather than to differences in HH tissue expression or pathophysiology. CPP associated with HH presents with isosexual development prior to the age of 8\u00a0years in girls and 9\u00a0years in boys. It is not uncommon for CPP with HH to present in children at an earlier age in comparison to other causes of CPP, including in infancy. Surgical resection of the HH can be effective for treating CPP, but is reserved for patients with intractable epilepsy, since GnRH agonists are widely available and effective treatment. Other endocrine disturbances with HH are rare, but can include growth hormone deficiency, hypothyroidism, and adrenal insufficiency. Diabetes insipidus is commonly encountered postoperatively, but is not observed with HH prior to surgical intervention.<\/jats:p>","DOI":"10.1111\/epi.13756","type":"journal-article","created":{"date-parts":[[2017,6,7]],"date-time":"2017-06-07T20:35:26Z","timestamp":1496867726000},"page":"50-59","source":"Crossref","is-referenced-by-count":75,"title":["Hypothalamic hamartoma with epilepsy: Review of endocrine comorbidity"],"prefix":"10.1111","volume":"58","author":[{"given":"Victor S.","family":"Harrison","sequence":"first","affiliation":[{"name":"Division of Endocrinology Department of Pediatrics Children's Hospital of Philadelphia Philadelphia Pennsylvania U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Oatman","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Hypothalamic Hamartoma Program Phoenix Children's Hospital Phoenix Arizona U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John 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