Adrenal androgens as predictors of growth characteristics in premature pubarche

BACKGROUND: Premature pubarche (PP) is characterized by the early onset of pubic or axillary hair, body odor, or mild acne, most commonly reflected by elevated plasma dehydroepiandrosterone-sulfate (DHEA-S) concentrations. However, recent evidence suggests that 11-oxygenated adrenal androgens [11β-hydroxyandrostenedione (11OHA4), 11β-hydroxytestosterone (11OHT)] may better represent true androgenic activity. AIM: This study aims to evaluate the predictive value of adrenal androgens in determining growth characteristics among girls with PP. SUBJECTS AND METHODS: A prospective study was conducted to evaluate anthropometric and clinical features and to quantify plasma adrenal androgens-including DHEA, DHEA-S, androstenedione (A4), androsterone, 11OHA4, and 11OHT-using liquid chromatography-mass spectrometry in 53 girls with isolated PP at presentation and during follow-up. Thirty-six age-matched girls without PP served as the control group. RESULTS: The height, body mass index-standard deviation score (SDS), DHEA, DHEA-S, A4, androsterone, and 17OH-pregnenolone concentrations were higher (P < .0001), whereas no difference in 11OHA4 and 11OHT concentrations was observed in the PP group compared with controls. There was no correlation of adrenal androgen concentrations with height, corrected height, and growth velocity at baseline or during follow-up of 2.7 years. Corrected height SDS was positively correlated with baseline corrected height SDS (r = .63, P < .0001), baseline bone age (BA)/chronological age ratio (r = .31, P = .02), and baseline BA SDS (r = .32, P = .01) but not with hormone concentrations. CONCLUSION: Isolated idiopathic PP appears to be a benign variant of normal development. In this setting, adrenal androgen concentrations are not associated with adverse linear growth outcomes and are unlikely to influence clinical management, supporting a conservative approach after exclusion of pathological causes.