Premature adrenarche: novel lessons from early onset androgen excess

Idkowiak, Jan; Lavery, Gareth G.; Dhir, Vivek; Barrett, Timothy; Stewart, Paul M.; Krone, Nils; Arlt, Wiebke

doi:10.1530/eje-11-0223

Cited by 110 publications

(90 citation statements)

References 165 publications

(157 reference statements)

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“…Adrenarche is clinically characterized by development of axillary odor, pubic hair, and skin oiliness, whereas in gonadarche the initial clinical manifestation is thelarche in girls and a bilateral increase in testicular volume in boys (4).…”

Section: Introductionmentioning

confidence: 99%

Central precocious puberty: revisiting the diagnosis and therapeutic management

Brito

Spinola-Castro

Kochi

et al. 2016

Arch. Endocrinol. Metab.

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Clinical and laboratory diagnosis and treatment of central precocious puberty (CPP) remain challenging due to lack of standardization. The aim of this revision was to address the diagnostic and therapeutic features of CPP in Brazil based on relevant international literature and availability of the existing therapies in the country. The diagnosis of CPP is based mainly on clinical and biochemical parameters, and a period of follow-up is desirable to define the "progressive" form of sexual precocity. This occurs due to the broad spectrum of pubertal development, including isolated premature thelarche, constitutional growth and puberty acceleration, progressive and nonprogressive CPP, and early puberty. Measurement of basal and stimulated LH levels remains challenging, considering that the levels are not always in the pubertal range at baseline, short-acting GnRH is not readily available in Brazil, and the cutoff values differ according to the laboratory assay. When CPP is suspected but basal LH values are at prepubertal range, a stimulation test with short-acting or long-acting monthly GnRH is a diagnostic option. In Brazil, the treatment of choice for progressive CPP and early puberty is a long-acting GnRH analog (GnRHa) administered once a month or every 3 months. In Brazil, formulations of GnRHa (leuprorelin and triptorelin) are available and commonly administered, including 1-month depot leuprorelin 3.75 mg and 7.5 mg, 1-month depot triptorelin 3.75 mg, and 3-month depot leuprorelin 11.25 mg. Monthly or 3-month depot GnRHa are effective and safe to treat CPP. Arch Endocrinol Metab. 2016;60(2):163-72

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Section: Introductionmentioning

confidence: 99%

Central precocious puberty: revisiting the diagnosis and therapeutic management

Brito

Spinola-Castro

Kochi

et al. 2016

Arch. Endocrinol. Metab.

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“…Some studies have implicated that girls with premature adrenarche seem to be at increased risk of ovarian hyperandrogenism, polycystic ovarian syndrome (12), insulin resistance, and metabolic syndrome (13,14). Therefore, we found it important to study the timing of gonadarche and pubarche and the possible associations with adrenal androgen levels and fat accumulation in healthy Danish children.…”

Section: Introductionmentioning

confidence: 94%

The pubertal transition in 179 healthy Danish children: associations between pubarche, adrenarche, gonadarche, and body composition

Mouritsen

Aksglæde

Soerensen

et al. 2013

European Journal of Endocrinology

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Background: Pubertal onset is usually defined by breast development in girls and testicular growth in boys. Pubarche is defined as the attainment of pubic hair and is considered as a sign of pubertal transition. Pubarche is preceded by a gradual increase in production of adrenal androgens, DHEA and D4-androstenedione (Adione), a process termed adrenarche. Objective: To study the natural course of pubertal transition and the associations with adrenarche, body fat, and linear growth. Design and methods: A longitudinal study of 179 healthy children (89 girls) with higher socioeconomic background examined every 6 months for 5 years. Pubic hair stage, breast stage, genital stage, testicular volume (TV), height, weight, and four skinfolds were measured. Results: In girls, median age (25th and 75th percentiles) at thelarche (B2C) was 10.1 years (9.3-10.9). In boys, median age at attaining a TV O3 ml was 11.5 years (10.9-12.0). Median age at pubarche (PH2C) was 10.9 years (10.3-11.4) in girls and 11.6 years (10.8-12.4) in boys. Only 6.8% (4/59) of the girls and 24.6% (15/61) of the boys developed pubic hair as the first isolated sign of puberty. Serum DHEAS and Adione increased with age, although the increase in Adione was most pronounced in girls. No associations between early age at thelarche/testicular growth and increased body fat (BMI and sum of four skinfolds) were observed. Conclusion: Danish children rarely experience pubarche as the first sign of puberty. No associations between age at pubertal onset and body composition were found. Circulating levels of Adione, but not DHEAS, increased with the onset of puberty, although with large interindividual variability.

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“…It is unclear whether exposure to sex steroids may have similar adverse effects. Evidence from human populations suggests that the prevalence of insulin insensitivity and polycystic ovarian syndrome is higher in the presence of excess androgen hormones (Veiga-Lopez et al 2008, Moulana et al 2011, and it has been suggested that exposure to excess androgen in childhood influences the development of the metabolic syndrome and polycystic ovarian syndrome (Idkowiak et al 2011). In adult humans, male subjects show an increased propensity to at least some aspects of the metabolic syndrome compared with females, possibly as a primary effect of ambient sex steroid levels (Regitz-Zagrosek et al 2006).…”

Section: Exposure To Sex Steroidsmentioning

confidence: 99%

Sex differences in developmental programming models

2013

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The theory of developmental programming suggests that diseases such as the metabolic syndrome may be 'programmed' by exposure to adverse stimuli during early development. The developmental programming literature encompasses the study of a wide range of suboptimal intrauterine environments in a variety of species and correlates these with diverse phenotypic outcomes in the offspring. At a molecular level, a large number of variables have been measured and suggested as the basis of the programmed phenotype. The range of both dependent and independent variables studied often makes the developmental programming literature complex to interpret and the drawing of definitive conclusions difficult. A common, though under-explored, theme of many developmental programming models is a sex difference in offspring outcomes. This holds true across a range of interventions, including dietary, hypoxic, and surgical models. The molecular and phenotypic outcomes of adverse in utero conditions are often more prominent in male than female offspring, although there is little consideration given to the basis for this observation in most studies. We review the evidence that maternal energy investment in male and female conceptuses may not be equal and may be environment dependent. It is suggested that male and female development could be viewed as separate processes from the time of conception, with differences in both timing and outcomes.Reproduction (2013) 145 R1-R13

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Premature adrenarche: novel lessons from early onset androgen excess

Cited by 110 publications

References 165 publications

Central precocious puberty: revisiting the diagnosis and therapeutic management

Central precocious puberty: revisiting the diagnosis and therapeutic management

The pubertal transition in 179 healthy Danish children: associations between pubarche, adrenarche, gonadarche, and body composition

Sex differences in developmental programming models

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