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Premature adrenarche: Etiology, clinical findings, and consequences.
[congenital adrenal hyperplasia]
Adrenarche
means
the
morphological
and
functional
change
of
the
adrenal
cortex
leading
to
increasing
production
of
adrenal
androgen
precursors
(
AAPs
)
in
mid
childhood
,
typically
at
around
5
-
8
years
of
age
in
humans
.
The
AAPs
dehydroepiandrosterone
(
DHEA
)
and
its
sulfate
conjugate
(
DHEAS
)
are
the
best
serum
markers
of
adrenal
androgen
(
AA
)
secretion
and
adrenarche
.
Normal
ACTH
secretion
and
action
are
needed
for
adrenarche
,
but
additional
inherent
and
exogenous
factors
regulate
AA
secretion
.
Inter-individual
variation
in
the
timing
of
adrenarche
and
serum
concentrations
of
DHEA
(
S
)
in
adolescence
and
adulthood
are
remarkable
.
Premature
adrenarche
(
PA
)
is
defined
as
the
appearance
of
clinical
signs
of
androgen
action
(
pubic
/
axillary
hair
,
adult
type
body
odor
,
oily
skin
or
hair
,
comedones
,
acne
,
accelerated
statural
growth
)
before
the
age
of
8
years
in
girls
or
9
years
in
boys
associated
with
AAP
concentrations
high
for
the
prepubertal
chronological
age
.
To
accept
the
diagnosis
of
PA
,
central
puberty
,
adrenocortical
and
gonadal
sex
hormone
secreting
tumors
,
congenital
adrenal
hyperplasia
,
and
exogenous
source
of
androgens
need
to
be
excluded
.
The
individually
variable
peripheral
conversion
of
circulating
AAPs
to
biologically
more
active
androgens
(
testosterone
,
dihydrotestosterone
)
and
the
androgen
receptor
activity
in
the
target
tissues
are
as
important
as
the
circulating
AAP
concentrations
as
determinants
of
androgen
action
.
PA
has
gained
much
attention
during
the
last
decades
,
as
it
has
been
associated
with
small
birth
size
,
the
metabolic
and
polycystic
ovarian
syndrome
(
PCOS
)
,
and
thus
with
an
increased
risk
for
type
2
diabetes
and
cardiovascular
diseases
in
later
life
.
The
aim
of
this
review
is
to
describe
the
known
hormonal
changes
and
their
possible
regulators
in
on-time
and
premature
adrenarche
,
and
the
clinical
features
and
possible
later
health
problems
associating
with
PA
.
Diseases
Validation
Diseases presenting
"increasing production of adrenal androgen precursors"
symptom
congenital adrenal hyperplasia
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