What is premature adrenarche in precocious puberty?

Updated: Nov 30, 2020
  • Author: Paul B Kaplowitz, MD, PhD; Chief Editor: Robert P Hoffman, MD  more...
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Premature adrenarche (also referred to as premature pubarche) refers to the early appearance of pubic hair, axillary hair, or both in children without other signs of puberty. [32] An adult-type axillary body odor is the other major clinical finding. Signs of severe androgen excess (eg, clitoral enlargement, growth acceleration, severe acne) should prompt further investigation to exclude a rare virilizing tumor or a variant form of congenital adrenal hyperplasia.

The etiology of premature adrenarche is an earlier than usual increase in the secretion of weak androgens by the adrenal gland. Although regulation of adrenal androgen secretion is poorly understood, it is distinct from that of gonadal steroids. Therefore, early appearance of pubic hair may not temporally correlate with the appearance of breast development and is generally not a cause for concern. It is common practice to obtain a bone age in such patients to exclude a more serious disorder, but since bone age is often advanced by 2 years or more, the value of the bone age in this setting may be questioned. [33]

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