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Premature Adrenarche—Normal Variant or Forerunner of Adult Disease?¹

Endocrinology Unit, Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain 08950 (L.I.); Division of Pediatric Endocrinology (J.D.-N., P.S.), Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York 10467; and Hormonal Laboratory (N.P.), Hospital Materno-Infantil, Vall d’Hebron, Autonomous University of Barcelona, Barcelona, Spain 08035

Adrenarche is the puberty of the adrenal gland. The descriptive term pubarche indicates the appearance of pubic hair, which may be accompanied by axillary hair. This process is considered premature if it occurs before age 8 yr in girls and 9 yr in boys.

The chief hormonal product of adrenarche is dehydroepiandrosterone (DHEA) and its sulfated product DHEA-S. The well documented evolution of adrenarche in primates and man is incompatible with either a neutral or harmful role for DHEA and implies most likely a positive role for some aspect of young adult pubertal maturation and developmental maturation. Premature adrenarche has no adverse effects on the onset and progression of gonadarche in final height.

Both extra- and intraadrenal factors regulate adrenal androgen secretion. Recent studies have shown that premature adrenarche in childhood may have consequences such as functional ovarian hyperandrogenism, polycystic ovarian syndrome, and insulin resistance in later life, sometimes already recognizable in childhood or adolescence. Premature adrenarche may thus be a forerunner of syndrome X in some children. The association of these endocrine-metabolic abnormalities with reduced fetal growth and their genetic basis remain to be elucidated.

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