Table 5.

Premature adrenarche summary

• Premature adrenarche is the most common cause of the isolated premature onset of pubic hair development (before 8 years in girls, before 9 years in boys). • It is a very mildly hyperandrogenic condition that is slowly progressive and is often (or alternatively) associated with mild acne and increased axillary body odor. • It is more common in girls, which may reflect a sexual dimorphism in androgen metabolism or action. • The treatment is symptomatic with anticipatory guidance. • Although it typically seems to be a variant of normal development, premature adrenarche is frequently associated with a mildly advanced growth pattern, obesity, and insulin resistance and possibly an increased risk of mood disorder and hyperandrogenism. • The adult outcome of premature adrenarche remains to be well-defined. • Premature adrenarche is characterized by a distinctive serum steroid pattern in which serum DHEAS is typically 40 to 130 µg/dL (1.08-3.5 µmol/L), as determined by direct radioimmunoassay, and testosterone and its precursors are no greater than normal for early female puberty • Clinical steroid assay methodology is advancing: LCMSMS, due to its higher specificity, results in serum DHEAS levels nearly half those by direct radioimmunoassay, and customary norms for other sex steroids may well change in the near future. • The differential diagnosis includes idiopatnic premature pubarche, hypertrichosis, topical androgen exposure, true precocious puberty, nonclassic 21-hydroxylase deficiency congenital adrenal hyperplasia and other more rare virilizing disorders, including neoplasia, that collectively cause 5% to 10% of cases. • An algorithmic approach to the differential approach is suggested for the consulting endocrinologist in which further testing for virilizing disorders is advised for cases with atypical advancement of BA or atypically increased baseline serum DHEAS, testosterone, or 8 am 17-hydroxyprogesterone.