Evidence for dissociation between adrenarche and gonadarche: studies in patients with idiopathic precocious puberty, gonadal dysgenesis, isolated gonadotropin deficiency, and constitutionally delayed growth and adolescence.

Abstract

To test the hypothesis that adrenarche and the activation of the hypothalamic-pituitary-gonadal axis (gonadarche) are independent and dissociated events, controlled by separate mechanisms, we examined the relationship between adrenarche and gonadarche in patients with a variety of clinical disorders of sexual maturation. The concentration of plasma dehydroepiandrosterone sulfate (DHEA-S) was used as a hormonal marker of adrenal androgen secretion. The 26 patients with idiopathic precocious puberty exhibited two distinct patterns. Seventeen patients with onset of puberty before 6 yr of age had a mean plasma concentration of DHEA-S which was not different from that of normal prepubertal, preadrenarchal children of the same sex, chronological age (CA; 1–6 yr), and bone age (BA; 1–10 yr). In contrast, 9 patients with onset of precocious puberty between 6 and 8 yr of age had a mean DHEA-S plasma concentration greater than that of agematched prepubertal children (86.4 ± 13.9 vs. 10.0 ± 2.2 μg/dl; P < 0.004) and...