ESPE Abstracts

Introduction: Adrenarche is characterized by the activation of androgen precursors which are released from the zona reticularis of the adrenal gland. Dehydroepiandosterone (DHEA) is a weak androgen and its conversion to slightly more potent androgens such as Dehydroepiandosterone- sulfate (DHEA-S) is thought to be responsible for the clinical signs of adrenarche. Premature adrenarche is one of the most common endocrine abnormalities causing concern among peripubertal children and their parents. Recent studies have demonstrated that adrenal production of 11-oxygenated steroids such as 11-ketotestosterone, 11 hydroxyandrostenedione, and 11-beta- hydroxytestosterone are also potent adrenal androgens that can bind to androgen receptors and therefore likely play a role in the clinical picture of adrenarche.

Objective: The objective of the study is to determine if levels of 11-oxo androgens can be used as a new more sensitive biochemical marker for diagnosis of premature adrenarche in females.

Methods: A chart review study was conducted that looked at laboratory and anthropometric data of female patients who presented with history of symptoms associated with premature adrenarche before 8 years of age.

Results: A total of 28 subjects were collected. Of the 16 subjects who had normal DHEA and/or DHEA-S, 12 (75%) had elevated 11 oxoandrogens (defined as one or more). We also noted that 11-ketotestosterone and 11- hydroxyandrostenedione were elevated more consistently than 11-hydroxytestoterone.

Conclusions: Seventy five percent of patient with normal DHEA/DHEA-S had elevated 11-oxo androgens, indicating that their symptoms are likely related to the effect of oxo androgens as opposed to simply DHEA/DHEA-S. Therefore, 11-oxo androgens could be used as novel biomarkers to evaluate premature adrenarche for patients in whom previous biochemical evaluation yielded inconclusive results.