title: Pubarche as well as thelarche may be a marker for the onset of puberty.
abstract: OBJECTIVE
  To define anthropometric and hormonal differences in a group of black and white girls who began puberty with breast development alone ("thelarche" pathway) compared to those who began with pubic hair development alone ("pubarche" pathway), and test the hypothesis that pubarche may represent true pubertal development.
  
  
  METHODS
  Longitudinal cohort seen annually for ten years.
  
  
  METHODS
  Recruited through elementary schools in Cincinnati, OH, and Richmond, CA; through HMO in Washington, DC.
  
  
  METHODS
  9 years old, either Black or White, in the National Heart, Lung, and Blood Institute Growth and Health Study.
  
  
  METHODS
  None; observational study.
  
  
  METHODS
  Initial secondary sexual characteristic at onset of puberty; anthropometric measures; hormone measures.
  
  
  RESULTS
  478 of 1155 girls matured through a defined pathway. Age at onset of secondary sexual characteristics was similar between pathways, although girls in the thelarche pathway had puberty at a somewhat younger age, and black participants entered at a significantly younger age. Height velocity was the same in both pathways, and in the pubertal range. DHEA-S levels at onset of puberty were significantly greater in girls in the pubarche pathway, but levels of estradiol and testosterone were not different. Age of menarche was different by race (younger in blacks) and pathway (younger in thelarche pathway).
  
  
  CONCLUSIONS
  Given similar age and height velocities at onset of secondary sexual characteristics, these results suggest that pubarche, the development of pubic hair without breast development, may represent true pubertal maturation.
authors.affiliation: Division of Adolescent Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45229-3039, USA. frank.biro@cchmc.org
authors.forename: Frank M
authors.initials: FM
authors.lastname: Biro
authors.forename: Bin
authors.initials: B
authors.lastname: Huang
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Daniels
authors.forename: Anne W
authors.initials: AW
authors.lastname: Lucky
mesh_terms: D017668:Age of Onset; D044383:Black People; D002648:Child; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D011627:Puberty / Q000208:ethnology*; D044465:White People