Premature adrenarche
Premature adrenarche
Arch Dis Child doi:10.1136/archdischild-2011-300011
Rachel M Williams, Caleb E Ward, Ieuan A Hughes Department of Paediatrics, University of Cambridge, Box 116 Addenbrooke's Hospital, Hills Road, Cambridge
Early development of secondary sexual hair in children is a concern for their parents and often leads to a paediatric referral.
This article gives a good explanation of the generally benign condition of premature adrenarche, and how to differentiate the rare other conditions that need to be considered. There is a useful algorithm in the article.
While premature adrenarche is generally considered a benign condition, there may be associated morbidities to consider/monitor.
The article is available at: http://adc.bmj.com/content/early/2011/08/11/archdischild-2011-300011.abstract?papetoc
MIKE
Abstract
Premature adrenarche refers to the presence of secondary sexual hair in girls younger than 8 years old and boys younger than 9 years old. It is a relatively common presentation to paediatricians and is more frequent in girls than boys. It is a benign diagnosis, but other causes of androgen excess such as congenital adrenal hyperplasia or adrenal tumours should be excluded first. In conjunction with history and clinical examination, first line investigations should include determination of serum androgen concentrations, along with bone age, proceeding to synacthen stimulation test (for 17OHP levels) and adrenal ultrasound if indicated. The phenotype of premature adrenarche varies considerably between populations but may be associated with low birth weight, insulin resistance, adverse cardio-metabolic risk and progression to polycystic ovarian syndrome in some populations. In the majority of cases, no specific treatment is recommended, but where there is a history of low birth weight, with associated insulin resistance, intervention with the insulin sensitising agent metformin may be considered on a case by case basis.
Mike
Prof Mike South,
Royal Children's Hospital, Parkville, Victoria 3052, Australia
