Premature adrenarche may start earlier than one thinks

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Premature adrenarche (PA) is marked by the early development of public hair accompanying the presence of increased circulating androgens before 8 (girls) or 9 (boys) years of age. There have been conflicting reports of growth irregularities in children with PA, which have been difficult to reconcile with the known effects of these androgens.

In the current issue of The Journal, Utriainen et al in Finland present some fascinating information on 54 girls with well-characterized PA—in fact, many had a much more extensive workup than what might be considered appropriate in practice. The study was made possible because of excellent clinical and growth records on these children.

Girls with PA had no differences in birth weight or length, in contrast to some earlier reports. They did, however, experience accelerated growth in length as early as within the first year of life—well before there was any evidence of andrenarche. Early gain in length standard deviation score proved to be an independent risk factor for the subsequent development of PA. The authors speculate that this early phenomenon may be related to increases in insulin-like-growth-factor 1 levels, but the design of this study precluded testing this hypothesis.