Determinants of pubertal progression and final height in premature pubarche

Premature pubarche (PP), defined as the early onset of pubic hair and often associated with mild androgen excess, is a common reason for referral to a pediatric endocrinologist. A small proportion of cases may progress to central precocious puberty (CPP). Data on the factors determining pubertal tempo and associated growth outcomes in these individuals are limited.

To identify predictors of pubertal progression and final height (FH) in girls with PP and to evaluate growth outcomes in those progressing to CPP.

We retrospectively analyzed 88 girls with PP who attained FH; 13 progressed to CPP (PP-to-CPP). Auxological data, bone age (BA), pubertal development, and plasma androgen profiles were evaluated.

At presentation, corrected height SDS (CH-SDS) in girls with PP correlated with BA-SDS and BA/chronological age (BA/CA) ratio (p=0.03 and p=0.007). Corrected FH-SDS was positively associated with baseline CH-SDS in both PP and PP-to-CPP groups (p<0.001 and p=0.0002). Compared with PP, the PP-to-CPP group had higher baseline CH-SDS, BA-SDS and BA/CA ratio (all p=0.02). Baseline CH-SDS was the strongest independent predictor of corrected FH-SDS (p<0.001), while BMI-SDS showed a negative association (p=0.003). Baseline dehydroepiandrosterone-sulfate (DHEA-S) was not associated with CH-SDS, BA advancement, progression to CPP, or corrected FH-SDS in either group. Receiver operating characteristic (ROC) analyses for progression to CPP identified a BA/CA cutoff of 1.2; and a CH-SDS cutoff of 1.8 (p=0.01).

Growth relative to genetic potential and skeletal maturation at presentation were the strongest predictors of progression to CPP and FH outcomes in girls with PP. Although DHEA-S reflects adrenal maturation and early androgen exposure, baseline DHEA-S concentrations were not associated with progression to CPP or long-term growth outcomes in our cohort.