ESPE Abstracts

Introduction: Premature adrenarche refers to appearance of pubic hair and sometimes axillary hair before eight and nine years in girls and boys respectively. The most constant sign is the appearance of pubic/axillary hair. Furthermore, other signs of androgen effect (adult type body odor, acne, greasy hair, accelerated statural growth) are valuable to complete the diagnosis. However, it is important to be mentioned that no virilization signs are associated with this disorder. Its diagnosis is settled after exclusion of the causes of androgen excess such as simple virilizing congenital adrenal hyperplasia, adrenal and gonadal androgen producing tumors and exogenous androgens.

Case presentation: A 7-year-old girl was referred with a six months history of itching in the peri-anal area. The mother noticed presence of hair in this area. Thus, she sought medical advice. No history of any local treatment for this area. Her height was on the 50th centile, while her weight was on the 75th centile. Examination revealed normal female genitalia with no ambiguity or hyperpigmentation. Using Tanner staging for pubertal development assessment, breast was T1 (no breast development), no pubic hair or axillary hair. There were long, dark and coarse hairs noted in the perianal area. Hormonal assessment revealed normal basal and post ACTH stimulation cortisol and 17-OH progesterone levels. Furthermore, she had normal androstenedione, testosterone. Although, DHEA-s was slightly elevated than normal for age and sex. Bone age was within average for chronological age (not advanced). Ultrasound on adrenal glands and internal female genitalia was unremarkable. Thus, she was diagnosed as premature adrenarche and no treatment was given for the girl. After two months, she developed fine hair on labia majora. So, adrenal protocol CT was done and was unremarkable. After six months of follow up, the course was stationary with no new clinical signs.

Conclusion: Peri-anal area examination should be put into consideration during examination for assessing pubertal development. Furthermore, peri-anal hair may be an early sign for premature adrenarche.