title: The pubertal transition in 179 healthy Danish children: associations between pubarche, adrenarche, gonadarche, and body composition.
abstract: BACKGROUND
  Pubertal onset is usually defined by breast development in girls and testicular growth in boys. Pubarche is defined as the attainment of pubic hair and is considered as a sign of pubertal transition. Pubarche is preceded by a gradual increase in production of adrenal androgens, DHEA and Δ4-androstenedione (Adione), a process termed adrenarche.
  
  
  OBJECTIVE
  To study the natural course of pubertal transition and the associations with adrenarche, body fat, and linear growth.
  
  
  METHODS
  A longitudinal study of 179 healthy children (89 girls) with higher socioeconomic background examined every 6 months for 5 years. Pubic hair stage, breast stage, genital stage, testicular volume (TV), height, weight, and four skinfolds were measured.
  
  
  RESULTS
  In girls, median age (25th and 75th percentiles) at thelarche (B2+) was 10.1 years (9.3-10.9). In boys, median age at attaining a TV >3 ml was 11.5 years (10.9-12.0). Median age at pubarche (PH2+) was 10.9 years (10.3-11.4) in girls and 11.6 years (10.8-12.4) in boys. Only 6.8% (4/59) of the girls and 24.6% (15/61) of the boys developed pubic hair as the first isolated sign of puberty. Serum DHEAS and Adione increased with age, although the increase in Adione was most pronounced in girls. No associations between early age at thelarche/testicular growth and increased body fat (BMI and sum of four skinfolds) were observed.
  
  
  CONCLUSIONS
  Danish children rarely experience pubarche as the first sign of puberty. No associations between age at pubertal onset and body composition were found. Circulating levels of Adione, but not DHEAS, increased with the onset of puberty, although with large interindividual variability.
authors.affiliation: Department of Growth and Reproduction, GR-5064, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. annette.mouritsen@rh.regionh.dk
authors.forename: Annette
authors.initials: A
authors.lastname: Mouritsen
authors.forename: Lise
authors.initials: L
authors.lastname: Aksglaede
authors.forename: Kaspar
authors.initials: K
authors.lastname: Soerensen
authors.forename: Casper P
authors.initials: CP
authors.lastname: Hagen
authors.forename: J H
authors.initials: JH
authors.lastname: Petersen
authors.forename: Katharina M
authors.initials: KM
authors.lastname: Main
authors.forename: Anders
authors.initials: A
authors.lastname: Juul
mesh_terms: D000293:Adolescent; D050499:Adrenarche / Q000502:physiology; D000886:Anthropometry; D001823:Body Composition / Q000502:physiology*; D015992:Body Mass Index; D002648:Child; D003718:Denmark; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011627:Puberty / Q000502:physiology*