Premature Adrenarche—Normal Variant or Forerunner of Adult Disease?1
Lourdes Ibáñez,
Joan DiMartino-Nardi,
Neus Potau and
Paul Saenger
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
descriptiveterm pubarche indicates the appearance of
pubic hair, whichmay be accompanied by axillary hair. This process is
consideredpremature 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
documentedevolution of adrenarche in primates and man is incompatible
witheither a neutral or harmful role for DHEA and implies most likely
apositive role for some aspect of young adult pubertal maturationand
developmental maturation. Premature adrenarche has no adverseeffects
on the onset and progression of gonadarche in finalheight.
Both extra- and intraadrenal factors regulate adrenal androgen
secretion.Recent studies have shown that premature adrenarche in
childhoodmay have consequences such as functional ovarian
hyperandrogenism,polycystic ovarian syndrome, and insulin resistance
in laterlife, sometimes already recognizable in childhood or
adolescence.Premature adrenarche may thus be a forerunner of syndrome
Xin some children. The association of these endocrine-metabolic
abnormalitieswith reduced fetal growth and their genetic basis remain
tobe elucidated.
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