Premature adrenarche

Adrenarche is the onset of the production of male hormones by the adrenal glands. The adrenal glands are triangular organs that sit on top of the kidneys. They produce male hormones among others – in girls as well as in boys. Clinically significant adrenarche most often starts together with puberty (stimulation of the ovaries, visible as breast development), but sometimes it starts earlier or later. If production starts before the age of 8 years in girls/9 years in boys, it is referred to as “premature adrenarche”. 

The disorder is caused by an early increase in male hormones (androgens) from the adrenal glands.  A cause for the premature onset of hormone production usually cannot be detected. In rare cases, a problem in cortisol production in the adrenal glands or local overproduction in one adrenal gland is identified as the cause. 

• A physical exam is performed to check for signs of possible early puberty (breast development) 
• A blood sample is taken to analyse the hormone levels  
• An X-ray of the hand and wrist is taken to determine bone age  

Premature adrenarche is characterised by: 

• Pubic and/or axillary hair growth 
• Body odour, especially in the armpits 
• Absence of breast development in girls or of genital enlargement in boys  
• Growth acceleration 

Generally, premature adrenarche does not cause health problems. Girls with premature adrenarche may have periods a bit earlier than the average, but usually not before age 10. Girls have an increased risk of developing PCOS (polycystic ovary syndrome) in their teenage years. 

As puberty changes are normal, only earlier than usual, no treatment needs to be given to these children.