ESPE Abstracts

Obese children are at risk for increased DHEAS production, which is assumed to arise from hyperinsulinemia, hyperleptinemia, increased IGF-1 production or chronic low grade inflammation. Exaggerated adrenarche is suspected to be a forerunner of polycystic ovary syndrome in girls, but its consequences in obese boys are less well studied. In this study we evaluated the presence of exaggerated adrenarche in a cohort of obese boys and girls and investigated whether obese children with an exaggerated adrenarche are at higher risk for a more advanced pubertal maturation, dyslipidemia or a more central obesity. Fasting serum insulin, IGF-1, leptin and DHEAS (by automated immuno-assays), fibrinogen and lipid levels (by standard laboratory methods) were measured in 234 (99 male) overweight (BMI SDS >1.3) children, aged between 4 and 17.5 years (median 9.9 years), before the start of a weight loss program. Skinfolds thickness at four sites and waist circumference were measured, as well as Tanner stage and body fat percentage (by bio-electrical impedance analysis) were assessed. Data on birth history and familial history of obesity were collected. Logarithms of all hormones were standardised for age using residuals of a simple regression analysis (res). Spearman Rank and Pearson correlations tests and Mann-Whitney U tests were performed. DHEAS concentration increased significantly (<0.005) with age (r=0.706), insulin (r=0.501), IGF-1 (r=0.442), leptin (0.403) and fibrinogen (0.181). The log DHEAS res correlated significantly with log insulin res (r=0.216, P< 0.001) and log leptin res (r=0.160, P< 0.05), as well as with birth weight SDS (r=−0.241, P<0.001) and waist SDS (r=0.221, P<0.001). The 23 (14 male) children with a DHEAS conc. above 2.4 mg/l, compared to the obese children with levels below this upper reference limit in adolescence, were older (P<0.005) and had higher median serum insulin (P<0.005) and IGF1 (P<0.005) concentrations, but a comparable median waist SDS, BMI SDS and body fat percentage. Significantly (P<0.05) lower HDL cholesterol concentrations and a more advanced genital development were observed in the adolescent (age >10 years) boys with an exaggerated adrenarche. In conclusion, exaggerated adrenarche is observed in 10% of obese children, appears to be driven by compensatory hyperinsulinemia and is associated with lower HDL cholesterol levels and a more advanced genital development in adolescent boys.