Differences in Endocrine Parameters and Psychopathology in Girls with Premature Adrenarche versus On-time Adrenarche

Abstract

Girls with premature adrenarche (PA) are at risk for multiple problems related to exaggerated androgen synthesis. Whether PA carries a risk of psychopathology remains unknown. This study examined group differences in: (a) anthropometric and endocrine parameters, and (b) mood and behavior problems, in 6-8 year-old girls with PA (n = 40) compared to on-time adrenarche girls (n = 36). PA girls were taller (p ≤0.05) and heavier (p ≤0.01) than the on-time adrenarche girls but body mass index showed no difference. PA girls had significantly (p <0.05) higher adrenal androgen and testosterone concentrations but not cortisol or leptin. PA girls also had significantly more oppositional defiant disorder, and higher symptom counts reflecting anxiety, mood or disruptive behavior disorders. PA girls may be more vulnerable to psychopathology than on-time adrenarche girls. The challenge of future studies is to determine which PA girls are at risk for psychopathology and which are more resilient.

Adrenarche and Middle Childhood

“…However, these studies do little to suggest specific mechanisms by which DHEAS might have an impact on behavior. Dorn et al (2008) have recently shown, based on a sample of 40 girls 6 to 8 years of age with premature adrenarche (PA), that compared with normal controls, those with PA are heavier and exhibit elevated levels of DHEA, but not cortisol. These findings are as expected, given findings linking DHEA to body composition discussed earlier.…”

“…The key role of cortisol, another adrenal steroid, in regulating the energy supply to the brain (Peters et al 2004) suggests that increasing production of DHEA/S, and its known antiglucocorticoid properties Pélissier et al 2006Pélissier et al , 2004Yildirim et al 2003), may provide neuroprotection to the developing brain throughout middle childhood when glucose utilization is substantially elevated (Chugani 1998). Nonetheless, despite demonstrated behavioral effects of DHEA/S in rodents (e.g., Mizuno et al 2006;Navar et al 2006), clear evidence for effects of DHEA/S on behavior in children is almost entirely limited to clinical conditions (Dorn et al 2008;Strous et al 2001;Van Goozen et al 1998. In contrast, we know relatively little about the role of DHEA/S in normal human development.…”

One-Year Follow-Up of Girls with Precocious Puberty and Their Mothers: Do Psychological Assessments Change over Time or with Treatment?

“…To what degree girls with CPP actually experience such distress and whether treatment with GnRHa alters the psychological trajectory in these patients is unknown. Although considered a variation of normal development, some studies have suggested an increased risk for psychopathology and behavioral problems in girls with PA [12– 14]. How common these issues are in girls with PA and whether they change over time has likewise not been explored.…”

Children with a History of Premature Adrenarche Have Good Health-Related Quality of Life at the Age of 12 Years

“…However, a previous study investigated psychosocial health in a cohort of prepubertal girls with PP [7]: PP girls had a higher rate of oppositional defiant disorder and more symptoms related to anxiety, social and specific phobias, depression and hyperactivity than the control girls. Additionally, these PP girls had more parent- and/or teacher-reported internalizing and externalizing symptoms, social and behavioral problems, and aggressive behavior [7]. On the other hand, psychological assessments were similar in PA girls and girls with early normal or precocious puberty in another study [8].…”

“…It has recently been suggested that earlier timing of adrenarche and higher concentrations of adrenal androgens may be associated with psychopathology in children [6]. In one case-control cohort, prepuber tal girls with premature pubarche (PP), some with low DHEAS concentrations, had a higher rate of oppositional defiant disorder and higher symptom counts reflecting anxiety, mood or disruptive behavior disorders than the control girls [7]. In another study, however, there were no differences in psychological assessments between prepubertal PA girls and girls with early normal or precocious puberty [8].…”