Review Question - QID 106334

Premature activation of the adrenal glands can result in premature adrenarche, defined as the isolated appearance of axillary hair before six years of age.

The premature appearance of axillary hair is due to abnormally early androgen secretion from the adrenal glands. Premature adrenarche is associated with an increased bone age but that is less than or equal to 120% of the height age, DHEA-S level 40-115 ug/mL, and/or testosterone level less than 20 ng/mL. For the most part, the condition is clinically insignificant and benign.

Rosenfield notes that premature adrenarche can have ramifications in adulthood. It may be a harbinger of diabetes mellitus type II or metabolic syndrome, especially in girls who are coincidentally obese.

Herman-Giddens et al. discovered that a substantial population of girls in the U.S. are developing pubertal characteristics at younger ages. This is concerning as premature pubarche is more often associated with CNS disorders; therefore, premature pubarche frequently necessitates a more thorough workup (see illustration A).

Illustration A is an algorithm for evaluating premature pubarche.

Incorrect answers:
Answers 1, 2: Early activation of the hypothalamus and pituitary leads to increased production of GnRH and gonadotropins (e.g. FSH, LH), respectively. This is termed early gonadarche.
Answer 4: Tumors may result in premature puberty, but these would tend to produce frank virilizing signs rather than isolated axillary hair development.
Answer 5: The ovaries produce estrogen and progesterone, which are responsible mainly for thelarche (breast development) and maturation of the genitalia.