Unfavorable Hormonal and Psychologic Profile in Adult Women with a History of Premature Adrenarche and Pubarche, Compared to Women with Polycystic Ovary Syndrome

Abstract

If circulating adrenal androgens levels rise before the age of 8 years in girls, this phenomenon is termed premature adrenarche (PA), while the concomitant appearance of pubic hair is called premature pubarche (PP). Girls with PA-PP display an unfavorable hormonal profile compared to their normal peers and have an increased risk of developing polycystic ovary syndrome (PCOS) features peripubertally. However, the sequelae of premature adrenarche remains unclear. We assessed metabolic, hormonal, psychologic profiles, and ovarian morphology in 21 women of mean age (±SD) 21.3±3.3 years, BMI: 23.6±4.4 kg/m2 with PA-PP, 45 women with PCOS and 26 controls, matched for age and BMI. PA-PP women displayed a favorable lipid profile compared to PCOS and controls. Insulin resistance index (HOMA-IR), however, were similar in PA-PP and PCOS women (2.09±1.42, 2.08±0.83) and higher than controls (1.13±0.49, p <0.05). Circulating androstenedione levels did not differ between PA-PP and PCOS women (0.11±0.05 vs. 0.12±0.03), but was higher than that of controls (0.02±0.0 nmol/l, p <0,05). Ovarian volume was increased in PA-PP and PCOS (11.14±3.3 vs. 10.99±4.61) compared to controls (6.74±1.83 cm3). PA-PP women had a higher score of state/trait anxiety and depressive and eating disorder symptoms than controls, with a pattern that matched that of PCOS women. Only 14% of the PA-PP group fulfilled the Rotterdam PCOS criteria. Some women with a history of PA-PP displayed hormonal and psychologic profile similar to PCOS, and accordingly a regular monitoring of these girls during adulthood is advised.

Polycystic ovary syndrome and type 2 diabetes mellitus: A state-of-the-art review

“…In the latter subgroup, hyperandrogenemia does not seem to correlate with IR indices or metabolic abnormalities in most[ 38 - 42 ], but not all, studies[ 43 , 44 ]. It is a riddle that remains as yet unresolved, especially taking into consideration that such an association does seem to exist in other conditions of adrenal hyperandrogenism, such as premature adrenarche/pubarche[ 45 ].…”

Congenital adrenal hyperplasia: The importance of screening and clinical assessment

“…GnRH agonist was commenced, to suppress puberty, plus tamoxifen as a selective oestrogen receptor modulator to block the oestrogen effect on the growth plate and preserve the best possible final height. Despite optimal management ongoing, she will be short for her family expectation (148 cm; <3rd centile, MPH 155 cm; 10th percentile), may experience later adolescent mood changes 5,6 and polycystic ovary syndrome as a consequence of the very early puberty and might wish for future genital surgery at such time that she could make a personal informed decision 7,8 . All these issues could have been avoided with early recognition of the signs of androgen excess.…”

Early anthropometric indicators of type 2 diabetes mellitus

“…Another hypothesis is that earlier exposure to estrogen in girls increases the percentage of visceral body fat and decreases sex-hormone-binding globulin [36], thus increasing the risk of insulin resistance and T2DM. Of note, premature pubarche/adrenarche can be an early indicator of polycystic ovarian syndrome [37], which is strongly correlated with T2DM.…”