Background: Premature pubarche refers to the appearance of pubic hair without other signs of puberty or virilization before 8 years in girls and 9 years in boys. The etiology of premature pubarche is not known. It has been suggested that an early maturation of the zona reticularis of the adrenal cortex is at the basis of premature pubarche, leading to an increase of adrenal androgens to levels that are normally seen in early puberty. In alternative, in children with normal androgen levels, premature pubarche might be due to hypersensitivity of hair follicle to steroid hormones. At present, predictor factors able to identify the evolution of premature pubarche are not known.
Objective and hypotheses: To evaluate the etiology of premature pubarche in a cohort of Italian children, and to detect some predictor factors able to identify the evolution of pubarche.
Method: We evaluated all children born between 2001 and 2014 and referred to Pediatric Endocrinology Service of our hospital for a premature pubarche. All of them were submitted to clinical exams to identify the etiology of premature pubarche. In particular, bone age and hormonal levels were determined.
Results: We identified 334 children (F 271, M 63) with premature pubarche. In the 92.5% of them premature pubarche was idiopathic and in 6.6% it resulted in a central precocious puberty, while in 0.9% a nonclassic forms of congenital adrenal hyperplasia was detectable. The only predictive factor for an idiopathic premature pubarche was the BMI. We identified an early maturation of the zona reticularis of the adrenal cortex by finding higher DHEAS levels than 40 μg/dl and higher Δ4-androstenedione levels than 0.81 ng/ml.
Conclusion: In most cases the premature pubarche was idiopathic, leading to an increased BMI. Higher values of DHEAS than 40 μg/dl and higher Δ4-androstenedione than 0.81 ng/ml suggest that premature pubarche was progressing.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology