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Adrenarche is when the adrenal cortex produces more androgens in preparation for puberty. Premature adrenarche can cause early physical changes and behavioral problems. Girls with early adrenarche are at risk of developing hormonal disorders later in life. Diagnosis is done through a physical exam and urinalysis, and treatment varies among doctors.
Adrenarche occurs in children between the ages of six and eight when the adrenal cortex begins to produce increased amounts of androgens in preparation for the onset of puberty. During this time, the adrenal cortex will enlarge and differentiate into three separate sections, each responsible for producing a specific steroid hormone. Occasionally, a child will start adrenarca years before the normal age. Excess androgen hormones can cause premature changes in the baby’s body.
The onset of adrenarche changes the configuration of the adrenal cortex. Three divisions occur within the body of the adrenal cortex, so each segment produces a different steroid hormone. The zona reticularis begins to generate androgens, the zona glomerulosa produces mineralocorticoids, and the zona fasciculata creates glucocorticoids.
Premature adrenarche, or a state of early sexual maturation, is suspected when a child begins to develop some of the physical characteristics of an adult. The first indication is usually an increase in noticeable body odor. Hair may start growing in the armpits and near the groin. Acne can also begin to develop as androgen production increases.
Children with early and excessive androgen production are more likely to have behavioral problems. Boys with premature adrenarche are often more aggressive than other children of the same age. Girls and boys with the condition may have difficulty adjusting to classmates and may become depressed or withdrawn.
Research indicates that girls with premature adrenarche are more likely to develop other hormonal disorders later in life. Polycystic ovary syndrome (PCOS) is more common among women with a history of early-onset adrenarche. These girls are also at increased risk of fertility problems due to malfunction of the reproductive and endocrine systems.
One cause of premature androgen production may be weight gain. Overweight children are more likely to be seen by a doctor for evaluation of early sexual maturation. Premature development of androgens can result in insulin resistance which could lead to diabetes.
Diagnosing premature adrenarche requires only a short office visit. A physical exam will be done to confirm signs of early sexual maturation, and a urinalysis will be done. Ketosteroids present in urine often indicate the beginning of androgen production.
The recommended treatment for premature androgen production varies from doctor to doctor. Some doctors suggest daily medications to reduce the amount of androgens produced. Cyproterone acetate, ketoconazole, and spironolactone are antiandrogen drugs used to treat boys and girls with this condition. Many doctors do not believe that medications are helpful and only recommend watching your child for the early development of other puberty features.
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