Premature adrenarche--a common condition with variable presentation

Area of Science:

• Pediatric Endocrinology
• Adolescent Medicine
• Metabolic Disorders

Background:

• Adrenarche is a normal maturational increase in adrenal androgens (DHEA, DHEAS).
• Premature adrenarche (PA) presents with clinical signs of androgen excess before age 8/9 years.
• PA is associated with elevated DHEA(S) levels and signs like pubic hair, acne, and body odor.

Purpose of the Study:

• To define premature adrenarche (PA) and its clinical manifestations.
• To highlight diagnostic considerations for PA, excluding other androgen excess conditions.
• To discuss the metabolic implications and follow-up recommendations for PA.

Main Methods:

• Clinical observation and biochemical assessment of children with signs of early androgen action.
• Differential diagnosis to exclude congenital adrenal hyperplasia, tumors, precocious puberty, and exogenous androgens.
• Review of associated metabolic features and long-term outcomes.

Main Results:

• PA is characterized by early pubic/axillary hair, acne, body odor, and accelerated growth.
• Overweight and higher adiposity, particularly in girls, are common in PA.
• PA is linked to metabolic issues like hyperinsulinism, dyslipidemia, and potential future ovarian hyperandrogenism.

Conclusions:

• PA is a common condition requiring recognition of clinical signs and exclusion of other causes.
• Children with PA, especially those who are overweight, need monitoring for metabolic health and lifestyle factors.
• Further research is needed to understand the long-term persistence of metabolic changes into adulthood.