title: Premature adrenarche: novel lessons from early onset androgen excess.
abstract: Adrenarche reflects the maturation of the adrenal zona reticularis resulting in increased secretion of the adrenal androgen precursor DHEA and its sulphate ester DHEAS. Premature adrenarche (PA) is defined by increased levels of DHEA and DHEAS before the age of 8 years in girls and 9 years in boys and the concurrent presence of signs of androgen action including adult-type body odour, oily skin and hair and pubic hair growth. PA is distinct from precocious puberty, which manifests with the development of secondary sexual characteristics including testicular growth and breast development. Idiopathic PA (IPA) has long been considered an extreme of normal variation, but emerging evidence links IPA to an increased risk of developing the metabolic syndrome (MS) and thus ultimately cardiovascular morbidity. Areas of controversy include the question whether IPA in girls is associated with a higher rate of progression to the polycystic ovary syndrome (PCOS) and whether low birth weight increases the risk of developing IPA. The recent discoveries of two novel monogenic causes of early onset androgen excess, apparent cortisone reductase deficiency and apparent DHEA sulphotransferase deficiency, support the notion that PA may represent a forerunner condition for PCOS. Future research including carefully designed longitudinal studies is required to address the apparent link between early onset androgen excess and the development of insulin resistance and the MS.
authors.affiliation: School of Clinical and Experimental Medicine, Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: Jan
authors.initials: J
authors.lastname: Idkowiak
authors.forename: Gareth G
authors.initials: GG
authors.lastname: Lavery
authors.forename: Vivek
authors.initials: V
authors.lastname: Dhir
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Barrett
authors.forename: Paul M
authors.initials: PM
authors.lastname: Stewart
authors.forename: Nils
authors.initials: N
authors.lastname: Krone
authors.forename: Wiebke
authors.initials: W
authors.lastname: Arlt
mesh_terms: D050499:Adrenarche / Q000502:physiology*; D000328:Adult; D017668:Age of Onset; D000728:Androgens / Q000032:analysis / Q000097:blood*; D000818:Animals; D005260:Female; D006801:Humans; D008297:Male; D008954:Models, Biological; D009994:Osmolar Concentration; D011629:Puberty, Precocious / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors
chemical_list: D000728:Androgens