Prevalence of Adrenal Pathology in Children Referred for Premature Pubarche: A 10-Year Retrospective Review in an...

The early onset of pubic hair (premature pubarche [PP]) with or without adult body odor is a common reason for referral to pediatric endocrine clinics. Most children have premature adrenarche (PA), a benign variation of pubertal development, yet extensive laboratory evaluations are often performed due to concern for pathology. We aimed to determine the prevalence of adrenal pathology in children referred for PP and describe clinical characteristics of those with pathologic findings.

We performed a retrospective chart review of children referred for PP between January 2015 and December 2024.

Of 1,160 children, six (0.52%) had adrenal pathology, all of whom were diagnosed with congenital adrenal hyperplasia. Age at presentation did not differ between the PA and pathology groups. There was a trend toward lower mean body mass index z-scores in those with pathology. Males comprised 83% of the pathology group compared with 22% of the PA group.

Adrenal pathology among children referred for PP is exceedingly rare. Routine laboratory testing in the absence of additional signs of androgen exposure is not warranted.