ESPE Abstracts

Background: Premature adrenarche (PA) is characterized by the appearance of pubic and axillary hair associated with an increase in adrenal androgen production, in the absence of central puberty, steroidogenic enzyme defects, or virilizing tumors, before the age of 8 years in girls and 9 years in boys. Studies have shown increased likelihood of PA for children with obesity and those born small for gestational age (SGA).

Aim: To assess the correlation between PA in girls and age at puberty onset. Furthermore, to investigate whether girls with PA were born SGA, the association with their body mass index (BMI) and if the age at puberty onset was correlated with bone age advancement (BAA) and mother’s age of menarche.

Methods: Data from 81 prepubertal females with clinical signs of androgen action and elevated serum androgen levels were analyzed retrospectively from their medical records. Student's t-tests or Anova were used for the comparison of means between groups. Correlations between variables were evaluated using Pearson's correlation coefficient.

Results: Eighty-one prepubertal females with mean age 7.22 ±1.08 years were evaluated. Of those, non-classic CAH was diagnosed in seven girls and were excluded from our study. Mean BMI z-score was 1.44±1.04, 22 (29.7%) were obese, defined as BMI z-score ≥ 2, 23 (31.1%) were overweight (1<BMI z-score<2) whereas 29 (39.2%) were of normal weight. Birth weight data were available for 66/74 children. Five girls (7.58%) were born SGA. Mean age of adrenarche was 6.60±1.16 years, mean bone age was 8.27±1.37 years and the mean BAA was 0.972±0.831 years at baseline. Mean age at puberty onset was 8.99±1.14 years. The majority of girls (54.1%) entered puberty within normal range of age (9.99±0.79), whereas 25.7% in early normal range (8.56±0.25) and 20.3% had precocious puberty (7.62±0.34). The mean age of menarche of the mothers was 12.3±1.33 years. No significant correlation was found between age at adrenarche and BAA, however girls who developed early puberty had a greater BAA at diagnosis of PA (P=0.017). Moreover, overweight/obese girls had a greater BAA (P=0.018). Furthermore, there was a positive correlation with girls’ puberty onset and mothers’ age of menarche (r=0.308, P-value=0.019).

Conclusion: Children with PA tend to have increased BMI, advanced bone age and enter puberty earlier than general population. Advanced bone age seems to correlate with early onset of puberty. No significant correlations were found between PA and SGA.