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Premature adrenarche

more about Premature adrenarche

  • In this condition, there is early appearance of pubic hair, armpit hair, and armpit odor before the normal age.  The arbitrary age at which this is considered abnormal is age 8 years or earlier.
  • In premature adrenarche, there are no other signs of early puberty, except those listed above.  In some cases of premature adrenarche, pubic hair is the only physical change that makes an early appearance.
  • In premature adrenarche there are no signs of acne or the rapid growth in body size that occurs in puberty.  If those signs occur, some disease process is at fault.
  • Normal puberty does not begin before the age of 8 years.  Premature adrenarche occurs before age 8.

  • Curly pubic hair (not straight pubic hair)
  • Axillary hair
  • Axillary odor
  • No other signs of puberty

  • This is probably caused by an increased release of two of the sex hormones from the adrenal glands, years earlier than this normally would occur.  The names of these hormones are DHEA (dehydroepiandrosterone), and DHEAS (dehydroepiandrosterone sulfate).
  • The adrenal glands are 2 small glands, one seated on the top of each kidney.
  • The adrenal glands make some of the body's sex hormones, in addition to the hormones made by the testes and the ovaries.

  • Physical examination shows a child 8 years old or younger who has curly pubic hair, and possibly axillary hair and axillary odor.  There are no other signs of puberty.
  • There is no growth spurt at this age.
  • There is no acne at this age.
  • There is no deepening of the male voice at this age.
  • There is no increased size of the genitals at this age.
  • Hormone levels of DHEA and DHEAS are often elevated to the amounts seen early in puberty, higher than the levels seen in the average 8 year old.

  • African Americans are at increased risk.

  • No treatment is needed for this benign condition, but it is necessary to reexamine the child every 6 months to see if this might really be a case of precocious puberty (early puberty) or, in very rare situations: (a) a Brain Tumor or (b) an abdominal tumor or pelvic tumor that is releasing hormones, or (c) a defect in the adrenal gland, present from birth, called congenital adrenal hyperplasia.
  • These 6 signs could be worrisome, in premature adrenarche:
    1. Early appearance of acne 
    2. Early appearance of the deepened male voice
    3. Advanced bone age on an X-ray of the wrist, showing that the bones are more like a teenager's; children with advanced bone age might have congenital adrenal hyperplasia.
    4. Testosterone levels at the high levels seen in puberty
    5. Early appearance of the growth spurt that normally occurs in the teenage years; this makes the young child taller than his or her peers, but ultimately the growth plates in the long bones fuse shut earlier than they should (and the adult will end up being shorter than his or her peers).
    6. Enlarging breasts, enlarging clitoris, enlarging penis or testes
  • If the physician suspects that this were actually precocious puberty or a tumor causing the release of hormones, he would perform another detailed physical examination and measure the amount of various hormones in the blood, and perform a CAT scan or MRI scan of the brain, the abdomen, adrenal glands, and possibly the pelvis, to see if a tumor were present.

  • There are no complications from premature adrenarche alone

  • Your physician should examine your child for early appearance of pubic hair, axillary hair, axillary odor, or any other sign of early puberty (early acne, early breast enlargement, deepening male voice, early enlargement of the genitals, early appearance of the teenage growth spurt).
  • Showing these physical changes to your physician is especially necessary if the physical changes occur before age 8 years.

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