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.
Three-year prospective study.
Auxology, blood pressure (BP), biochemical analysis of blood and urine, pelvic ultrasound in girls.
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.
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.
- PREMATURE ADRENARCHE
- PRECOCIOUS PUBARCHE
- NORMAL GIRLS