title: Reference values for serum dehydroepiandrosterone-sulphate in healthy children and adolescents with emphasis on the age of adrenarche and pubarche.
abstract: OBJECTIVE
  Adrenarche is a component of normal pubertal development. Recent decades have witnessed changes in the timing and tempo of puberty in different populations. We aimed to obtain normative data on dehydroepiandrosterone-sulphate (DHEA-S) secretion in healthy children and to evaluate the age of adrenarche, pubarche and the DHEA-S levels at which pubarche starts in both sexes.
  
  
  METHODS
  Serum DHEA-S concentrations were measured in 531 healthy (291 female) Turkish children aged 1 month-18 years by an automated chemiluminescence method. Pubic hair development was evaluated. DHEA-S concentrations >108·4 nmol/l (40 μg/dl) were regarded as adrenarche. Age-related normative data were constructed. Age at adrenarche and pubarche and the DHEA-S levels at pubarche were estimated using ROC analyses.
  
  
  RESULTS
  Serum DHEA-S levels were high in the first 6 months of life then declined below 108·4 nmol/l (40 μg/dl) with a cut-off age of 0·46 years for girls and 0·61 years for boys with 98% and 96% statistical sensitivity. Stable minimum levels were observed for the following 5 years. The cut-off age for DHEA-S levels rising above 108·4 nmol/l (40 μg/dl) was 8·0 and 7·0 years for girls for boys, respectively. DHEA-S levels at transition from Tanner stage P1 to P2 was 90·5 nmol/l (33·4 μg/dl) in girls and 118 nmol/l (43·6 μg/dl) in boys. Median (CI) DHEA-S levels were 170·7(94·8-336) and 244(119·2-357·7) nmo/l [63(35-124) and 90(44-132) μg/dl] in girls and boys, respectively, with Tanner stage P2 pubic hair.
  
  
  CONCLUSIONS
  We established reference data of serum DHEA-S levels in a large group of children. Currently, adrenarche (DHEA-S>108·4 nmol/l) starts 1 year earlier in boys but higher DHEA-S levels are needed for transition from P1 to P2 in boys.
authors.affiliation: Zeynep Kamil Maternity and Children's Diseases Research and Training State Hospital, Altunizade, Istanbul, Turkey; Faculty of Medicine, Department of Pediatric Endocrinology, Marmara University, Pendik, Istanbul, Turkey.
authors.forename: Tulay
authors.initials: T
authors.lastname: Guran
authors.forename: Irfan
authors.initials: I
authors.lastname: Firat
authors.forename: Feyza
authors.initials: F
authors.lastname: Yildiz
authors.forename: Ipek
authors.initials: I
authors.lastname: Kaplan Bulut
authors.forename: Mahmut
authors.initials: M
authors.lastname: Dogru
authors.forename: Abdullah
authors.initials: A
authors.lastname: Bereket
mesh_terms: D000293:Adolescent; D050499:Adrenarche / Q000502:physiology*; D000367:Age Factors; D000728:Androgens / Q000097:blood; D002648:Child; D002675:Child, Preschool; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood*; D005260:Female; D005865:Gestational Age; D064368:Healthy Volunteers; D006801:Humans; D007223:Infant; D049449:Luminescence; D008297:Male; D011627:Puberty / Q000502:physiology*; D012372:ROC Curve; D012016:Reference Values; D012741:Sexual Maturation
chemical_list: D000728:Androgens; D019314:Dehydroepiandrosterone Sulfate