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Benign Premature Adrenarche

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21. 9 year old girl with breast development and first period but no axillary or pubic hair. Is this consistent with normal puberty or does this require investigation.

, the 1st pubertal milestone is typically breast development (thelarche), followed soon after by appearance of pubic hair (pubarche) and axillary hair and later by the 1st menstrual period (menarche)…” It adds: “ Premature appearance of only one specific pubertal milestone is generally considered a benign variant of development. Examples are precocious appearance of pubic and axillary hair before age 8 in girls and age 9 in boys, and precocious onset of breast development before age 8 in girls (...) .” In the section on symptoms, signs and diagnosis, the authors list: “ In girls, breasts develop, and pubic hair, axillary hair, or both appear. Girls may begin to menstruate. Body odor, acne, and behavior changes may develop in either sex. Height growth is initially rapid in both sexes, but premature closure of the epiphyses results in short adult stature. Testicular or ovarian enlargement occurs in precocious puberty but is usually absent in isolated precocious adrenarche.” Concerning diagnosis: “ Diagnosis

2008 TRIP Answers

22. Pubic hair of infancy: endocrinopathy or enigma? (Abstract)

, laboratory evaluation, and bone-age radiographs were unremarkable for all the infants. Of the infants that returned for follow-up, pubic hair resolved by the age of 11.0 +/- 1.5 months. From our experience and review of the literature, we suggest that isolated pubic hair of infancy is a benign entity. However, long-term follow-up needs to be done to determine if pubic hair of infancy is an atypical variant of premature adrenarche, which may place these patients at risk for later adult disease.

2006 Pediatrics

23. Isolated scrotal hair in infancy. (Abstract)

, suggesting a possible pathological condition (eg, precocious puberty, congenital adrenal hyperplasia, adrenal or genital tumors), or may be due to premature adrenarche. (...) Isolated scrotal hair in infancy. Nine male infants who developed scrotal hair with no other signs of virilization were evaluated. Median age for the development of scrotal hair was 4.5 months, and median age at presentation was 7.5 months. Endocrinologic investigations performed in 6 of the infants yielded normal findings. The scrotal hair receded at a mean age of 12 months, suggesting a transient benign event. The development of genital hair in boys under age 9 years is considered precocious

2006 Journal of Pediatrics

24. Puberty - Normal and Abnormal

growth follow 1-2 years after testicular enlargement. Pubic hair typically appears at a similar time. Pubic hair growth without other changes (premature adrenarche) suggests adrenal androgen production (congenital adrenal hyperplasia (CAH), Cushing's syndrome, adrenal tumour). 50-90% of boys have some degree of breast hypertrophy. Later signs include growth spurt, voice deepening, acne and facial hair. The growth peak starts 2-3 years earlier in girls. Growth spurts start with the hands and feet (...) . Tanner's stages of puberty in girls are summarised in the table below. [ ] Pubertal Stages in Girls Tanner stage Breasts Pubic hair Growth Other Other Stage 1 Prepubertal - elevation of papilla only. Prepubertal villus hair only. Basal level - 5 cm to 6 cm per year. Adrenarche. Ovaries grow and enlarge. Stage 2 Breast bud appears under an enlarged areola (mean age 11.2 years). Sparse hair along labia (mean age 11.9 years). Accelerated growth - about 7 cm to 8 cm per year. Clitoral enlargement

2008 Mentor

25. Clinical characteristics of 104 children referred for evaluation of precocious puberty. Full Text available with Trip Pro

with premature adrenarche were significantly taller and more overweight than the general population; a subgroup had evidence of accelerated growth and bone maturation but no worrisome endocrine findings. Acanthosis nigricans was found in 13% of the girls in this study, but the incidence of true endocrine pathology was very low. The majority of children being referred for precocious puberty have benign normal variants, with a very low incidence of endocrine pathology. Most girls presenting with minimal breast (...) findings, and differences from the population mean for height and percentage of ideal body weight in the different groups were determined. Most of the patients referred (87%) were female, and the two most common diagnoses made were premature adrenarche (46%) and premature thelarche (18%). Only 9% (all girls) were thought to have true precocious puberty. Two conditions not well described in the literature, pubic hair of infancy and premature menses, were found in 8 and 5%, respectively. Patients

2004 Journal of Clinical Endocrinology and Metabolism

26. Biochemical and Radiological Indicators of Cardiovascular Morbidity in Children With Premature Pubarche

premature adrenarche (PA), is the early appearance of pubic hair before the age of 8 in girls and before 9 in boys. It had been shown that PP results from excess adrenal androgens. The terms PP and PA are used synonymously and differ from premature (precocious) puberty, the early activation of hypothalamic-pituitary gonadal axis. The incidence of PP is almost tenfold higher in girls than in boys. PP in the absence of congenital adrenal hyperplasia, virilizing ovarian or adrenal tumors has been regarded (...) with PP. Serum triglyceride levels in premature adrenarche patients are higher when compared to controls throughout all stages of pubertal development. Boys with PP show reduced insulin sensitivity, independent of obesity, as observed in girls with PP. In Hispanic and Caribbean girls studies have shown prenatal influence on the development of PP. The lowest birth weights are found in this group of girls with PP who also have pronounced hyperinsulinism. Also, the presence of dyslipidemia in girls

2007 Clinical Trials

27. Are pubertal changes in girls before age 8 benign? (Abstract)

Are pubertal changes in girls before age 8 benign? The Lawson Wilkins Pediatric Endocrine Society recently issued new recommendations for the age at which puberty should be considered precocious, lowering the prevailing standards from 8 years to 7 years for white girls and to 6 years for black girls. The new recommendations were based on a single epidemiologic study that focused on the conditions of premature thelarche and premature adrenarche (both characterized by a single sign of puberty (...) that signs of puberty in 6- to 8-year-old girls should not be considered normal or benign. Implementation of the new guidelines for the evaluation of puberty will result in failure to identify conditions that respond to early intervention.

2003 Pediatrics

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