Exaggerated adrenarche in a cohort of Scottish children: clinical features and biochemistry

W. F. Paterson, S. F. Ahmed, L. Bath, M. D. C. Donaldson, R. Fleming, S. A. Greene, I. Hunter, C. J. H. Kelnar, A. Mayo, J. S. Schulga, D. Shapiro, P. J. Smail, A. M. Wallace

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    Abstract

    Objective
    To investigate the reported association between exaggerated adrenarche (EA) and reduced foetal growth and to identify possible risk factors for future morbidity in Scottish children with clinical features of EA.

    Design
    Three-year prospective study.

    Measurements
    Auxology, blood pressure (BP), biochemical analysis of blood and urine, pelvic ultrasound in girls.

    Results
    Fifty-two patients were recruited of whom one girl had nonclassical congenital adrenal hyperplasia (17-OHP 17 nmol/l) and one had insufficient blood for analysis. The final cohort comprised 42 girls of mean (SD) age 7 center dot 7 (0 center dot 99) and eight boys of 8 center dot 8 (0 center dot 67) years. Mean (SD) birth weight was 3 center dot 27 (0 center dot 49) and 3 center dot 10 (0 center dot 76) kg in girls and boys respectively. Height/weight SDS were 1 center dot 13/1 center dot 69 in girls and 1 center dot 69/1 center dot 88 in boys. Mean systolic/diastolic BP was 107 center dot 8/60 center dot 4 (50th-75th centile) in girls and 115 center dot 5/63 center dot 9 (75th-91st centile) in boys. Uterine and ovarian development was prepubertal. Median serum dehydroepiandrosterone sulphate (DHEAS) was 2 center dot 1 and 4 center dot 1 mu mol/l, androstenedione 3 center dot 1 and 3 center dot 8 nmol/l in girls and boys respectively, with DHEAS within the reference range/undetectable in 18/2 and androstenedione in 12/6 patients. Fasting insulin was 9 center dot 0 and 15 center dot 0 mU/l in girls and boys respectively, with concomitant low normal SHBG. Anti-Mullerian hormone (AMH) was 15 center dot 7 pmol/l in 27 girls, compared with 5 center dot 0 pmol/l in normal girls aged 5-8 years.

    Conclusions
    Our Scottish EA cohort showed female predominance, no evidence of reduced foetal growth, a tendency to overweight with commensurate mild hyperinsulinaemia and modest elevation of serum androgens in some patients. We have found raised AMH levels in the girls, indicating advanced ovarian follicular development.

    Original languageEnglish
    Pages (from-to)496-501
    Number of pages6
    JournalClinical Endocrinology
    Volume72
    Issue number4
    DOIs
    Publication statusPublished - Apr 2010

    Keywords

    • POLYCYSTIC-OVARY-SYNDROME
    • PREMATURE ADRENARCHE
    • PRECOCIOUS PUBARCHE
    • NORMAL GIRLS
    • HYPERANDROGENISM
    • HORMONE
    • SERUM
    • HYPERINSULINEMIA
    • MENARCHE
    • GROWTH

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