Body mass index at the presentation of premature adrenarche is associated with components of metabolic syndrome at puberty

Abstract

The aim of this study was to analyze the relationship between premature adrenarche (PA) and metabolic syndrome (MeS) parameters at presentation and during puberty. This study comprised 47 girls with PA. Age- and puberty-matched 22 healthy girls without PA were the control group. Patients were evaluated at admission (first evaluation) and later in puberty (second evaluation). Anthropometric measurements, lipid levels, and hormonal parameters were studied and oral glucose tolerance test was performed. Indices for insulin resistance (IR) were calculated. The study group was divided in subgroups according to body mass index (BMI) and compared with the control group. The age of the PA group at first evaluation was 8.0 ± 1.1 years; mean height SDS and BMI SDS were 0.4 ± 1.2 and 0.6 ± 0.9, respectively. Age of PA group at the second evaluation was 12.9 ± 2.4 years. Frequency of obesity and overweight was 14.9 and 23.4%. Dyslipidemia ratio was 28.3%. PA group had significantly higher BMI than controls. Mean insulin concentration was higher and mean glucose and FGIR were lower in PA group and also dyslipidemia ratio was 5.3 times higher in PA than controls (p = 0.040). In PA group, overweight/obese subjects had still higher BMI at second evaluation and also higher fasting glucose, insulin, HOMA-IR. However, PA children with exaggerated DHEAS concentrations compared to those without had similar BMI SDS, insulin sensitivity, and secretion indices and lipid profile at second evaluation. BMI SDS at first evaluation was positively correlated with HOMA-IR at puberty; however, there is no correlation between DHEAS at first evaluation and HOMA-IR at puberty.Conclusion: BMI at adrenarche is more important than prepubertal adrogen concentrations such as DHEAS, while predicting the IR in puberty. Long-term follow-up of children supports the observation that PA per se may be related to IR; however, the risk increases with obesity. What is Known: • Premature adrenarche (PA) is receiving more attention as evidence emerges for a relation between early androgen excess and metabolic syndrome. • The onset of the adrenal androgen production before 8 years in girls defined as PA. Pubarche, axillary hair, apocrine body odor, acne are typical phenotypic features of PA. What is New: • Body mass index at adrenarche is an important risk factor for development of insulin resistance in pubertal ages. • Degree of dehydroepiandrosterone sulfate elevation was not shown as a risk factor for insulin resistance.

Cardiometabolic Risk Profile Among Young Adult Females With a History of Premature Adrenarche

“…Hyperinsulinemia is a common finding among prepubertal children with PA [8, 9, 14] and the risk of decreased insulin sensitivity seems to be increased in girls with PA also at adolescence [7, 12]. In a study investigating Turkish girls with PP, decreased insulin sensitivity at pubertal age could be predicted mostly by prepubertal BMI [12]. Our current study findings indicate the risk of abnormalities in glucose metabolism persists to adult age and that the risk is strongly associated with central adiposity.…”

“…Some studies have reported also an unfavorable lipid profile [7, 10] or slightly increased blood pressure (BP) in prepubertal girls with PP [4]. A tendency to be overweight and hyperinsulinemic seems to persist at least until early puberty [7, 11, 12], and it has been suggested that PA is a risk factor for the development of later cardiometabolic abnormalities, such as the metabolic syndrome (MetS) [13]. However, the number of studies exploring long-term cardiovascular risk profile and adult outcomes of PA is limited.…”

Role of Body Weight in the Onset and the Progression of Idiopathic Premature Pubarche

“…PP has been associated with obesity, hyperinsulinemia, and hyperandrogenism; however, it is not clear whether the primum movens is overweight or hyperandrogenism. A higher prevalence of overweight among children with PP has been recently documented [47, 50-52], and body weight is thought to be involved in the onset of pubarche [1, 3]. Some studies have shown that overweight girls tend to experience an earlier onset and a more rapid evolution of puberty and pubarche [53-55].…”

Familial Hyperinsulinism due to HNF4A Deficiency and Benign Premature Adrenarche: A Case Report

“…Benign premature adrenarche (BPA) is a clinical diagnosis often associated with elevations of dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) for chronological age,. 9,10 If phenotypic signs of androgen activity, such as pubic and/or axillary hair, adult-type body odor, oily skin or hair, comedones, or accelerated growth velocity, are detected before the age of 8 in females or 9 in males, premature adrenarche is present. 9 Prior studies have found increased rates of obesity in children with BPA.…”