Childhood Metabolic Syndrome and Its Components in Premature Adrenarche

Abstract

Idiopathic premature adrenarche (PA) is diagnosed when androgenic signs make their appearance, for no obvious reason, before age 8 years in girls or 9 years in boys. Premature pubarche (PP), the major clinical manifestation of PA, has been associated with some elements of the metabolic syndrome (MBS) including hyperinsulinism. This cross-sectional study enrolled 63 prepubertal Finnish girls with PA of no obvious origin, 32 of whom also had PP, along with 80 age-matched control girls. The participants were from a homogeneous Northern European population having a low prevalence of nonclassical congenital adrenal hyperplasia. Compared to control girls, those with PA had a higher mean weight-for-height and a higher prevalence of childhood MBS, as diagnosed using either the modified Adult Treatment Panel III criteria (24% versus 10%) or the World Health Organization definition (16% versus 5%). Serum insulin levels during oral glucose tolerance testing, when adjusted for weight-for-height, were increased in the overall AP group. In contrast, only those with both PA and PP had increased insulin levels and decreased levels of sex hormone-binding globulin. There were no significant group differences in weight-for-height adjusted blood pressure, lipid levels, or blood glucose. The major factors in the increased prevalence of childhood MBS observed in prepubertal Northern European girls with PA are decreased insulin sensitivity and being overweight. Girls who also have PP have more marked metabolic changes. It might be reasonable to estimate insulin sensitivity in prepubertal girls having PA and a body mass index exceeding the 75th percentile.