To the question about premature adrenarche at girls (the literature review)

Abstract

The article contains the up to date information about pathogenesis and diagnostics of premature adrenarche. The first clinical feature of adrenarche is the development of pubic hair. Girls aged 5-7 year old start adrenarche when the adrenal glands increase production of androgens. The article describes mechanism of development adrenarche and premature adrenarche according to different specialists who had been researching this complex problem. International terminology has a term of precocious pubarche, which relates to premature or/and excessive adrenarche, the latter correlated with Russian diagnosis of premature adrenarche, when organic and genetic causes of precocious pubarche and precocious puberty had been excluded. The article shows an approach of Russian and international endocrinologists towards the differential diagnosis between premature adrenarche and other pathologies which were described above. Special attention has been given to a diagnosis of an atypical form of congenital adrenal hyperplasia, which presents with symptoms similar to premature adrenarche. The article has collected information from the literature published by international and Russian researchers regarding the structure of premature adrenarche. The article also highlights the problem of hyperandrogenic dysfunctions in childhood, their possible outcomes and management methods. Girls with premature adrenarche carry risks of developing puberty with clinical manifestation of hyperandrogenic syndrome and, consequently, developing polycystic ovary syndrome and insulin resistance. The article also presents an opinion of Russian and international specialists regarding non clinical and clinical markers of premature adrenarche. The question which remains under discussion: How physiological process of premature adrenarche is, and also to whom, how and at what age the prophylaxis of possible hyperandrogenic and metabolic dysfunctions should be given. The problem of premature adrenarche should be considered as multidisciplinary, as many various specialties such as paediatric endocrinologists, paediatricians, paediatric gynaecologists, geneticists, oncologists and clinical pharmacologists have been involved in finding solution to this problem.