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Premature adrenarche

Robert L Rosenfield, MD
Section Editor
Mitchell E Geffner, MD
Deputy Editor
Alison G Hoppin, MD


Adrenarche is the term for the maturational increase in adrenal androgen production that becomes biochemically apparent as a rise in dehydroepiandrosterone sulfate (DHEAS) at about six years of age in both girls and boys (figure 1). It represents a gradual change in the pattern of adrenal secretory response to corticotropin (adrenocorticotropic hormone, ACTH), characterized by a disproportionate rise of 17-hydroxypregnenolone and dehydroepiandrosterone (DHEA) relative to cortisol. This change primarily occurs in the zona reticularis of the adrenal cortex, the cells of which express a unique pattern of steroidogenic enzymes that includes expression of sulfotransferase 2A1 (SULT2A1), which catalyzes the formation of DHEAS, the major adrenarchal steroid (figure 2). (See "Normal adrenarche".)  

Although premature adrenarche is a variant of normal, it is associated with moderately increased risks for polycystic ovary syndrome, insulin resistance, and metabolic syndrome in adulthood.  

The causes, diagnosis, and management of premature adrenarche will be reviewed here. It is useful, however, to begin with a review of definitions used to describe the various aspects of premature sexual development as they relate to adrenarche.


The definitions used to describe normal and premature puberty and pubarche are as follows:

Puberty — Puberty is the stage of development during which secondary sex characteristics appear and there is a transition from the sexually immature to the sexually mature stage. True puberty (also termed "central" or "complete" puberty) results from activation of the hypothalamic-pituitary-gonadal (HPG) axis. Testicular enlargement is the usual first sign of gonadal activation (gonadarche) in boys, and breast development (thelarche) is the first sign in girls, with sexual hair development usually occurring later. The physiology and clinical stages of puberty are discussed in a separate topic review. (See "Normal puberty".)

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Literature review current through: Nov 2017. | This topic last updated: Nov 21, 2017.
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