Characteristics of Children with Premature Pubarche in the New York Metropolitan Area

Díaz, Alejandro; Bhandari, Sonal; Sison, Cristina; Vogiatzi, Maria

doi:10.1159/000137661

Cited by 23 publications

(26 citation statements)

References 68 publications

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“…Possible potentiating factors include adrenal hormones and insulin resistance, both of which are elevated in PA, and estrogen at the growth plate. The findings of this study support prior reports that cite advanced BA to be independently associated with obesity and PA (2,3,9). This is the first study that demonstrates a synergistic effect between PA and obesity on BA advancement.…”

Section: Discussionsupporting

confidence: 92%

Bone Age Advancement in Prepubertal Children With Obesity and Premature Adrenarche: Possible Potentiating Factors

Sopher

Jean

Zwany

et al. 2011

Obesity

101

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Obesity and premature adrenarche (PA) are both associated with bone age (BA) advancement of unclear etiology, which may lead to earlier puberty, suboptimal final height and obesity in adulthood. Our objective was to understand the hormonal and anthropometric characteristics of BA advancement in a spectrum of prepubertal children with and without obesity and PA. In this cross-sectional study of 66 prepubertal children (35 PA, 31 control, 5–9 years), body mass index (BMI) z-score, hormonal values and response to an oral glucose tolerance test were the main outcome measures. Subjects were divided into tertiles by BA divided by chronological age (BA/CA), an index of BA advancement. Subjects in the top tertile for BA/CA had the highest dehydroepiandrosterone sulfate (DHEAS), free testosterone (%), hemoglobin A1C, BMI z-score and weight (P < 0.05). BMI z-score (r = 0.47), weight (r = 0.40), free testosterone (%) (r = 0.34) and DHEAS (r = 0.30) correlated with BA/CA (P<0.02). Regression analysis showed greater BA/CA in PA compared to controls after controlling for weight (0.21 ± 0.56, p<0.004). An exploratory stepwise regression model showed that weight, estradiol and DHEAS were the strongest predictors of BA/CA accounting for 24% of its variance. Obesity was highly associated with BA advancement in this study of prepubertal children. In addition, children with PA had greater BA/CA at any given weight when compared to controls. These findings suggest a possible hormonal factor, which potentiates the effect of obesity on BA advancement in children with obesity and/or PA.

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Section: Discussionsupporting

confidence: 92%

Bone Age Advancement in Prepubertal Children With Obesity and Premature Adrenarche: Possible Potentiating Factors

Sopher

Jean

Zwany

et al. 2011

Obesity

101

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“…There are concerns that children with advanced BA who are taller than those in the same age bracket during prepubescence could ultimately have a lower final height than their predicted height in adulthood (22). In terms of the implications of our study findings, the finding that advanced BA is associated with elevated adrenal androgen levels independent of obesity indicates that attention must be paid to adrenal androgen levels even among non-obese prepubertal children.…”

Section: Discussionmentioning

confidence: 99%

Effects of Adrenal Androgen Levels on Bone Age Advancement in Prepubertal Children: Using the Ewha Birth and Growth Cohort Study

et al. 2017

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Bone age (BA) advancement in prepubertal children may be associated with earlier onset of puberty and obesity. This study aimed to define the effects of adrenal androgen levels on the advancement of BA in prepubertal children, independent of obesity. During July and August 2011, we examined BA in 200 prepubertal children aged 7–9 years who were part of the Ewha Birth & Growth Cohort Study. BA was assessed by the Greulich-Pyle method. An index of BA advancement was calculated as the ratio of BA to chronological age (CA) (BA/CA), and this ratio was classified into 3 tertiles. We analyzed the relationship between BA advancement and anthropometric characteristics and adrenal hormone levels. The number of overweight children increased from the first group to the third group (PTrend = 0.03). The levels of adrenal androgens showed a significant positive correlation with the tertile groups after adjusting for age and sex (testosterone: r = 0.26, P < 0.001; dehydroepiandrosterone: r = 0.21, P < 0.001; androstenedione: r = 0.20, P < 0.001). Further, after controlling for body mass index (BMI), sex, and age, the BA/CA was found to be positively correlated with androstenedione (β = 0.04, R2 = 3.7%) and testosterone levels (β = 0.05, R2 = 4.7%). Based on our results, it is suggested that adrenal androgen levels are associated with BA advancement independent of BMI.

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“…Our obese premature adrenarche and obese control groups have a greater number of subjects because of the prevalence of obesity and the common association between premature adrenarche and obesity, as recently reinforced in a retrospective study of premature pubarche patients in New York City(36). Thus the weight factor might be more strongly represented when comparing all obese versus lean subjects.…”

Section: Discussionmentioning

confidence: 91%

Utility of Early Insulin Response and Proinsulin to Assess Insulin Resistance

Jean

Hassoun

Hughes

et al. 2009

The Journal of Pediatrics

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Objective To determine whether obesity and premature adrenarche are additive events increasing the risk of insulin resistance and β-cell failure, using early insulin response (EIR) or the insulinogenic index and proinsulin as markers. Study design Prospective case-control study at a tertiary care academic medical center; 81 prepubertal, predominantly Hispanic children (34 M/47 F): Lean Control [(4M, 6F) age(y), 6.5±1.2; BMI-z, 0.08±0.6], Obese Control [(20M, 10F) age(y), 7.2±1.5; BMI-z, 2.5±0.5], lean premature adrenarche [(3M, 11F) age(y), 7.1±1.2; BMI-z, 0.09±0.6], and obese premature adrenarche [(7M, 20F) age(y), 7.3±1.0; BMI-z, 2.2±0.4]. Fasting glucose (G0), insulin (I0), PI0, androgen levels, IGF-1, IGFBP-1, and lipids were obtained. OGTT was performed. EIR was calculated as (I30 – I0)/(G30 – G0). Between group differences were assessed with two-way analysis of variance with interactions and associations explored with correlation/regression. Results EIR was greater in all obese patients with and without premature adrenarche. Combined analysis of the independent variables, obesity and premature adrenarche, showed that obese premature adrenarche had the greatest EIR. Obese subjects with premature adrenarche had greater fasting PI levels than their lean counterparts. Fasting PI/I ratio showed no statistical significance between groups. Conclusion We have used EIR and PI as markers to assess risk of insulin resistance and impaired insulin secretion, and have shown that obese children with premature adrenarche may be at greater risk for the development of pre-diabetes and T2DM than their lean counterparts.

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Characteristics of Children with Premature Pubarche in the New York Metropolitan Area

Cited by 23 publications

References 68 publications

Bone Age Advancement in Prepubertal Children With Obesity and Premature Adrenarche: Possible Potentiating Factors

Bone Age Advancement in Prepubertal Children With Obesity and Premature Adrenarche: Possible Potentiating Factors

Effects of Adrenal Androgen Levels on Bone Age Advancement in Prepubertal Children: Using the Ewha Birth and Growth Cohort Study

Utility of Early Insulin Response and Proinsulin to Assess Insulin Resistance

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