ESPE Abstracts

Background: Precocious pubarche (PP), defined as the development of pubic hair before 8 years of age in females could be the first sign of a hyperandrogenic condition.

Aim: The purpose of the study was to analyze the etiology of premature androgenization of girls with a history for PP and to evaluate their clinical, laboratory and ovarian ultrasound profile.

Material and methods: A total of thirty-nine girls with a history of PP were enrolled in this 5-year retrospective study at a tertiary medical center. The mean age of all included participants was 14.2±3.0 years (7-20 years). Data was collected on anthropometry, clinical features of hyperandrogenism and menstrual irregularities. Hormonal and metabolic markers were assessed and HOMA-IR was calculated. Ovarian ultrasound was performed. The overweight/obesity prevalence was defined according to IOTF age- and gender-specific BMI cut-offs.

Results: The historical data of PP was associated with a subsequent diagnosis of non-classic congenital adrenal hyperplasia (NCCAH) in 51.3% of the girls (n=20, mean age 13.8±3.6 years), polycystic ovary syndrome (PCOS) in 20.5% of the participants (n=8, mean age 14.9±2.1 years) and idiopathic PP in 28.2 % (n=11, mean age 14.5±2.4 years). NCCAH girls were significantly shorter (152.5±13.1 cm) compared to the PCOS (161.4±2.3 cm, P=0.038) and idiopathic PP girls (160.7±4.0 cm, P=0.033), respectively. Clinical symptoms of hyperandrogenism were present more often in NCCAH patients compared to the other two groups but only the presence of hirsutism reached a significantly higher rate (95.0%NCCAH vs. 75%PCOS vs. 45.5%idiopathic PP, P=0.005). Menstrual irregularities were found in 91.8% of girls with idiopathic PP compared to 35% of NCCAH (P=0.022) and 37.5% of PCOS patients (P=0.05), respectively. The overall prevalence of overweight/obesity was 20.5% and mean body weight and BMI did not differ between groups. No significant between-groups differences were found in the parameters of lipid and glucose metabolism. Testosterone and androstenedione levels were similar for all participants. Basal 17OHProgesterone levels were significantly higher in NCCAH females compared to the idiopathic PP girls (2.01±0.85 vs. 1.11±0.83 ng/ml, P=0.009) and correlated with the development of hirsutism (r=0.445, P=0.014). Polycystic ovaries were demonstrated in 15.4% of all participants, with a significantly higher rate in PCOS girls (50%) in comparison to NCCAH (5%, P=0.007) and idiopathic PP patients (9.1%, P=0.032).

Conclusion: PP in girls could be a warning sign of a pathologic hyperandrogenic condition and should be evaluated by endocrinologists.