Abstract
IntroductionIdiopathic premature adrenarche (IPA) is considered a normal variant of puberty, presenting more commonly in female patients. There are concerns as to whether IPA alters the final height of these girls. Our main objectives were to (a) compare the adult height of girls with IPA against their target height and (b) design a mathematical model to predict adult height at diagnosis in female patients with IPA.Materials and MethodsA cohort study of girls with IPA was conducted from the time of IPA diagnosis until adult height. The following data were collected: target height, perinatal history, anthropometric and biochemical variables and bone age at diagnosis, age at Tanner stage 2 and menarcheal age, and adult height. First, we performed a univariate statistical analysis after which we carried out a multiple linear regression analysis using adult height as the dependent variable.ResultsWe obtained data from 79 female patients diagnosed with IPA with a mean adult height of 164.6 cm (95% CI: 163.36–165.85 cm). The mean follow-up time was 6.60 years. Average age at Tanner stage 2 was 9.71 years. Mean menarcheal age was 11.64 years. There were no significant differences between target height and adult height. Of the several predictive models designed for these patients, one of them, which included bone age, obtained an R 2 value of 71%.ConclusionsAlthough slightly advanced puberty was observed among the girls with IPA, their adult height was preserved. The use of predictive models of adult height on diagnosis of IPA could facilitate closer follow-up of girls at risk of reduced adult height.
Highlights
Idiopathic premature adrenarche (IPA) is considered a normal variant of puberty, presenting more commonly in female patients
✓ Appearance of pubic and/or axillary hair before age 8 years; ✓ Absence of thelarche according to Tanner stage 1 of breast development [18]; ✓ DHEA-S > 40 μg/dl, though this was within the range of normal values for the Tanner stage of pubic hair development; ✓ Normal basal and stimulated 17-OH-progesterone values after ACTH stimulation test to rule out presence of nonclassical congenital adrenal hyperplasia; and ✓ Normal abdominal and pelvic ultrasound to rule out presence of adrenal or ovarian tumor
No previous reports have designed a predictive model for adult height in female patients with this diagnosis
Summary
Idiopathic premature adrenarche (IPA) is considered a normal variant of puberty, presenting more commonly in female patients. As the zona reticularis develops in the adrenal cortex, at approximately 5 to 8 years of age, there is a simultaneous increase of androgen precursors with weak androgenic activity, such as dehydroepiandrosterone (DHEA), its sulfate (DHEA-S), and androstenedione. This biological process, called adrenarche, is typical of humans and higher primates [1–3]. Premature adrenarche (PA) is determined by the presence of clinical signs of androgen action before the age of 8 years in addition to androgen precursors that are abnormally high for the patient’s prepubertal stage (Tanner 1) and more suitable for more advanced Tanner stages (Tanner 2-4) [2]. Once other causes of excess androgen production have been ruled out, such as adrenal or ovarian tumors, non-classical congenital adrenal hyperplasia, or exogenous androgen administration, a diagnosis of idiopathic premature adrenarche (IPA) may be considered, as IPA is a diagnosis of exclusion [6, 7]
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