Adrenarche - Premature

Premature

Premature adrenarche is the most common cause of the early appearance of pubic hair ("premature pubarche") in childhood. In a large proportion of children it seems to be a variation of normal development requiring no treatment. However, there are three clinical issues related to premature adrenarche.

First, when pubic hair appears at an unusually early age in a child, premature adrenarche should be distinguished from true central precocious puberty, from congenital adrenal hyperplasia, and from androgen-producing tumors of the adrenals or gonads. Pediatric endocrinologists do this by demonstrating advanced levels of DHEAS and other adrenal androgens, with prepubertal levels of gonadotropins and gonadal sex steroids.

Second, there is some evidence that premature adrenarche may indicate that there was an abnormality of intrauterine energy environment and growth. As mentioned above, premature adrenarche occurs more often in children with intrauterine growth retardation and in overweight children. Some of these same studes have demonstrated that some girls who display premature adrenarche may continue to have excessive androgen levels in adolescence. This can result in hirsutism or menstrual irregularities due to anovulation referred to as polycystic ovary syndrome.

Third, at least one report found an increased incidence of behavior and school problems in a group of children with premature adrenarche compared with an otherwise similar control group. To date such a relationship has neither been confirmed nor explained and there are no obvious management implications.