ESPE Abstracts

Background: Premature adrenarche (PA) is characterized by an advanced bone age (BA) relative to chronological age (CA); nevertheless, clinical importance of this is not entirely understood. Literature contains few data on the impact of increased BA on adult height (AH) in PA. Objective of this study is to assess AH in girls with PA, and factors influencing AH.

Methods: Retrospective analysis was carried out on 477 girls who had been diagnosed with PA in the previous 10 years. Patients with precocious puberty, congenital adrenal hyperplasia and adrenal tumors were excluded. 118 girls, reaching AH were included. Age of onset of symptoms, CA, pubic hair stage, BA, DHEAS level, height, BMI at diagnosis, target height (TH) were acquired from medical files. Multiple regression and ROC curves were used to determine factors affecting AH.

Results: Age at onset of the complaints, CA and BA at diagnosis were 6.6±1.3, 7.3±1.4, and 9.1±1.1 years, respectively. Pubic hair was T2 in 60.2% (71/118) of patients, and T3 in 39.8% (47/118). Height-SDS and BMI-SDS at diagnosis were 1.3±1.0 and 1.0±0.7, respectively. BA advancement was ≥2SD in 50.9% of patients,1-2 SD in 36.4%, and <1SD in 12.7%. 38.1% of patients had normal weight, 38.1% were overweight and 23.8% were obese. DHEAS was ≥35μg/dl in all patients, with a mean of 81.6±33.9μg/dl. Mean ages of thelarche and menarche were 9.8±0.8 and 12.2±0.8 years, respectively. Mean TH-SDS was -0.2±0.9, predicted adult height (PAH)-SDS at diagnosis was -0.7±1.3, and AH-SDS was -0.1±0.9. AH-SDS of patients were similar to TH-SDS (p:0.582). Adult height of 70.3% (83/118) of patients reached target height (AH-SDS≥TH-SDS), however in 29.7% of patients adult height was shorter than target height (AH-SDS<TH-SDS). Age of onset of symptoms, age at diagnosis and TH-SDS were similar between those who reached TH and those who did not. Patients who did not reach TH had more advanced BA, higher height-SDS, BMI-SDS, DHEA-SO4 levels and lower PAH-SDS at diagnosis. Annual change in BA after diagnosis was greater in this group (P<0.001). Most important factors affecting AH-SDS were BA-SDS and BMI-SDS at diagnosis (standardized β coefficient -0.864 and 0.762, respectively; r2=0.828; P=0.001). Threshold values that differentiated patients who did not reach TH from those who reached TH were 1.9SD for BA-SDS (AUC=0.898, P<0.001), and 2.1SD for BMI-SDS (AUC=0.864, P<0.001).

Conclusion: Girls with PA generally reached their target heights. In this cohort, advanced BA (≥2SD) and BMI-SDS≥2 have the greatest impact on adult height.