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

Abstract

Context Premature adrenarche (PA) is associated with childhood overweight and hyperinsulinemia; the long-term cardiometabolic outcome is unknown. Objective To study cardiometabolic profile in adult women with previous PA. Design and participants Thirty women with PA and 41 control subjects were followed from prepuberty to young adulthood. Main outcome measures Prevalence of the metabolic syndrome (MetS) and clinical and biochemical cardiovascular risk factors. Results There were no differences in the prevalence of MetS or in any parameters indicating dyslipidemia, hypertension, hepatosteatosis, atherosclerosis, or low-grade inflammation between the study groups. However, prevalence of insulin resistance (IR; P = 0.014) and acanthosis nigricans (P = 0.010) was higher in the PA group. Neither fasting glucose nor insulin concentrations differed between the study groups, but HbA1c [adjusted for body mass index (BMI) P = 0.011] and Homeostatic Model Assessment of Insulin Resistance (P = 0.044; BMI-adjusted P = nonsignificant) were higher in the PA group. Although BMI and fat percentage were comparable between the study groups, the PA group had higher central fat mass than the control group. In the whole study population, MetS and IR were associated with greater adult fat mass, but no prepubertal factors predicting later IR were found. Conclusion PA does not seem to be associated with MetS, dyslipidemia, hypertension, atherosclerosis, or low-grade inflammation in young adult women. However, some women with PA may be at an increased risk of unfavorable glucose metabolism, which is associated with increased central adiposity at adult age rather than determined by prepubertal factors.

Growth and adrenarche: findings from the CATS observational study

“…Premature adrenarche has been linked to hyperinsulinaemia and dyslipidaemia during puberty, adolescent presentations of polycystic ovarian syndrome, 44 and increased risk of metabolic syndrome with its significant comorbidity in adulthood, 3 although another recent study did not replicate this. 31 In our study, few participants reported phenotypic pubertal changes despite elevated androgen levels. Hormonal adrenarcheal changes can significantly precede physical changes, and early physical signs can be subtle and difficult to identify.…”

“…A follow-up study of the Finnish cohort 29 reported that young women (aged 16.5-23.5 years) who had experienced premature adrenarche continued to show evidence of insulin resistance and had a tendency towards central fat mass distribution, but that cardiometabolic risk factors were no longer associated with adrenarcheal timing (after accounting for BMI across the study population). 31 Further studies examining the long-term impact of adrenarcheal timing and androgen concentrations in late childhood are needed to further explore the trajectories of these risks, including studies of the impact of the normal variability associated with adrenarche as opposed to those diagnosed with premature adrenarche, for whom there are very few data. We found positive relationships between height, weight, BMI, waist circumference and obesity with salivary androgen concentration during adrenarche, in keeping with many previous studies using serum samples 1 32 although others report no association.…”

Pubertal timing in boys and girls born to mothers with gestational diabetes mellitus: a systematic review

“…As adrenarche and gonadarche frequently overlap, it is clinically not possible to distinguish if pubarche is caused by adrenal or testicular androgens in boys, however, it is likely that pubic hair develops as a consequence of adrenal androgen action in girls. Premature adrenarche has been traditionally regarded as benign variant of normal ‘puberty’, however, there is some evidence suggesting that children with premature adrenarche have metabolic dysfunction, in particular abnormal glucose metabolism ( 46 ).…”

Pubertal timing in boys and girls born to mothers with gestational diabetes mellitus: a systematic review

“…As adrenarche and gonadarche frequently overlap, it is clinically not possible to distinguish if pubarche is caused by adrenal or testicular androgens in boys, however, it is likely that pubic hair develops as a consequence of adrenal androgen action in girls. Premature adrenarche has been traditionally regarded as benign variant of normal ‘puberty’, however, there is some evidence suggesting that children with premature adrenarche have metabolic dysfunction, in particular abnormal glucose metabolism (45).…”

“…As adrenarche and gonadarche frequently overlap, it is clinically not possible to distinguish if pubarche is caused by adrenal or testicular androgens in boys, however, it is likely that pubic hair develops as a consequence of adrenal androgen action in girls. Premature adrenarche has been traditionally regarded as benign variant of normal 'puberty', however, there is some evidence suggesting that children with premature adrenarche have metabolic dysfunction, in particular abnormal glucose metabolism(45).To assess the dynamics of pubertal development accurately is difficult, both in the individual clinical setting but even more so based on observational studies. Tanner staging is an unequivocally accepted clinical tool to assess pubertal milestones(46), but prone to inter-observer differences(47,48) and over/under estimation of Tanner staging frequently occurs when being self-reported(49).…”