ESPE Abstracts (2019) 92 P2-4

Bone Age Advancement in Prepubertal Children with Premature Adrenarche

Rita Santos-Silva, Carla Costa, Cíntia Castro-Correia, Manuel Fontoura


Pediatric Endocrinology and Diabetology Unit, Department of Pediatrics, Centro Hospitalar Universitário de S. João, Porto, Portugal


Introduction: Premature adrenarche (PA) is usually define as the appearance of clinical signs of androgen action before the age of 8 years in girls and 9 years in boys, associated the serum DHEAS above 40µg/dl.

Aims: 1) To characterize a population of prepubertal children with PA regarding birth weight, anthropometry, growth velocity, height difference, bone age, IGF1 and DHEAS. 2) To compare IgF1, bone age, growth velocity and height difference in normal-BMI and overweight/obese PA children. 3) To correlate bone age advancement, DHEAS, BMI and IGF1 in this population.

Methods: Cross-sectional study of 44 children with PA (37 girls/7 boys), with a mean age of 7.5±1.1 years-old.

Data was collected from their healthy card regarding gestational age and birth weight.

Anthropometric evaluation and Tanner staging was performed by a trained observer. Weight, height and BMI were converted to SD (WHO charts). Growth velocity was converted to SD (Tanner height velocity charts). Bone age was evaluated by a single endocrinologist (Greulich-Pyle).

Target height was calculated from parents' height. Predicted height was assessed with the Bailey-Pinneau method. Height difference was defined as the difference between predicted height and target height.

In all children, IGF1 (converted to SD according to age/gender/ Tanner stage) and DHEAS were evaluated.

IGF1, bone age, growth velocity and height difference of normal-BMI PA children were compared to those of overweight/obese children, using independent samples t test.

The correlation between bone age advancement and DHEAS, BMI and IGF1 was performed using Pearson's correlation.

Results: Mean birth weight was -0.285±1.1SD. At prepuberty, 43% (19) had a normal BMI and 57% (25) were overweight or obese. Mean height was 0.96±0.93 SD. Mean height difference was 2.1±6.7 cm. Mean growth velocity was 1.4±1.8 SD. Mean bone age advancement was 1.1±1.1 years. Mean IGF1 levels were 2±1.4 SD. Mean DHEAS was 121±58 µg/dL.

Overweight/obese children had higher IGF1 levels (P=0.026) and presented a more advanced bone age (P=0.044) than normal-BMI children.

Bone age advancement was correlated with DHEAS (r=0.449; P=0.05) and IGF1 (r=0.342; P=0.015), but not with BMI.

Conclusion: Accordingly to previous knowledge, overweight and obese children present high levels of IGF1 and advanced bone age. In this particular group of PA children, there is an adrenal hyperfunction (higher levels of DHEAS) that seems to be more expressive in overweight and obese children and possibly contributes to a more rapid skeletal maturation.

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