Premature adrenarche

Abstract

Premature adrenarche refers to the presence of secondary sexual hair in girls younger than 8 years old and boys younger than 9 years old. It is a relatively common presentation to paediatricians and is more frequent in girls than boys. It is a benign diagnosis, but other causes of androgen excess such as congenital adrenal hyperplasia or adrenal tumours should be excluded first. In conjunction with history and clinical examination, first line investigations should include determination of serum androgen concentrations, along with bone age, proceeding to synacthen stimulation test (for 17OHP levels) and adrenal ultrasound if indicated. The phenotype of premature adrenarche varies considerably between populations but may be associated with low birth weight, insulin resistance, adverse cardio-metabolic risk and progression to polycystic ovarian syndrome in some populations. In the majority of cases, no specific treatment is recommended, but where there is a history of low birth weight, with associated insulin resistance, intervention with the insulin sensitising agent metformin may be considered on a case by case basis.

17-Hydroxyprogesterone in children, adolescents and adults

“…Early adrenarche is very common especially in children of Indian and African background and is usually benign. 7 Adrenarche can be distinguished in a USP from subtle defects in cortisol synthesis, but the USP is not sufficently sensitive to detect moderate elevation of 17-OHP metabolites in NC-CAH. In adrenarche, urinary androgen metabolites are raised for age so interpretation requires age-related reference ranges; cortisol metabolite excretion is also raised.…”

“…Insulin resistance may also develop through the metabolic effects of androgens. 7,13,14 The precise mechanism for cardiovascular risk is still unclear.…”

“…This is a period of development characterised by the appearance of pubic and axillary hair and increase in body odour in girls around 8 years of age and boys around 9 years of age. 7 Early adrenarche (premature adrenarche/pubarche) is a condition reflecting early development of the zona reticularis in the adrenal gland between the cortex and medulla secreting androgen. 8 CAH and adrenal tumours need to be excluded.…”

Diagnosing children with signs of early puberty: knowing when to test and when to just monitor

“…One of the most common diagnoses made in children referred for early puberty is premature adrenarche (PA) [2,3]. The characteristic presentation is a child between the ages of 4 and 8 who develops pubic and/or axillary hair, often accompanied by axillary odor but not breast development in girls or penis and/or testicular enlargement in boys.…”

Adrenarche: a cell biological perspective

“…Fairly frequently, adrenarche occurs in children at an earlier age than the average (premature adrenarche). Premature adrenarche has been associated with endocrine and metabolic abnormalities, including insulin resistance, obesity, and low birth weight, but the associations are relatively inconsistent and how they influence adrenarche is unknown (Williams et al 2012).…”