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Premature adrenarche: an audit of endocrine profile and management in the outpatient setting
  1. AS Alexopoulos1,
  2. N Bridges2,
  3. S Alexander2
  1. 1Imperial College London, London, UK
  2. 2Department of Paediatric Endocrinology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK

Abstract

Aims Premature adrenarche (PA) is a common reason for referral to a paediatric clinic. There is little data on the clinical characteristics of these patients from the United Kingdom. Our aim is to audit the clinical presentation and management of PA in the outpatient setting.

Subjects and methods The auxology, pubertal status and endocrine profile of all children with a diagnosis of PA in an inner-city hospital from 1/1/2010 to 31/12/2010 were retrospectively audited.

Results A total of 37 children were identified, the majority of whom were girls (84%). The mean age at presentation was 7.06 years (±2.26 years). 20/37 (54%) children were of an ethnic minority background, and the mean duration of symptoms was relatively long at 14.2 months. The mean height and weight SDS were 1.09 (±1.38) and 0.86 (±1.2) respectively. Although boys tended to be smaller, the mean BMI SDS was comparable (boys 0.83; girls 0.93). The majority of children presented with axillary hair stage 1 (84%) and pubic hair stage 2 (54%). Body odour was also a complaint in 54% of cases. Whilst all male patients were pre-pubertal, 26% of the older girls (mean age 9.13 years) had evidence of breast development. Most (89%) children had their 17 hydroxyprogesterone (mean 4.08±2.2 nmol/L) measured. Other adrenal androgens and testosterone levels were normal in all patients who were tested. Only a minority had gonadotrophins (40%) and bone age (46%) estimated. We proceeded to a Synacthen test in only three children (basal 17 hydroxyprogesterone levels of 2.3, 7.8 and 12.3 nmol/L). No underlying pathology was identified in any of these children, and the average length of follow-up was 5 months.

Conclusion Our audit demonstrates that parental concern over secondary sexual hair growth is a relatively common presentation in paediatric clinics. It is more common in girls presenting in a pre-pubertal state, with a small subset of older girls who may be pubertal with an antecedent history of PA. Baseline endocrine profile is reassuring in the vast majority and further dynamic testing is rarely needed. Our audit identified no underlying disease in this patient group.

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