[Premature pubarche is not always an innocent phenomenon]

Manouk Backes, Nitash Zwaveling-Soonawala, Gerdine A Kamp
Nederlands Tijdschrift Voor Geneeskunde 2012, 156 (43): A5147
Premature pubarche is defined as growth of pubic hair before the age of 8 years in girls and 9 years in boys. In most cases, it is caused by premature adrenarche, which is a premature increased synthesis of androgens in the adrenal gland and is considered to be relatively harmless. Premature pubarche can also result from severe pathology, which makes it necessary to find the cause of premature exposition to androgens. We present 3 girls, aged 5-8 years, with premature pubarche. They were eventually diagnosed with 'premature adrenarche', 'non-classical congenital adrenal hyperplasia' and 'adrenal adenoma', respectively. No treatment is indicated for premature adrenarche. The patient with non-classical congenital adrenal hyperplasia was treated with hydrocortisone; in the patient with an adrenal adenoma - a rare but severe condition - the adenoma was resected. The diagnoses were established based on progression of growth, bone age and serum levels of dehydroepiandrosterone sulfate (DHEAS), androstenedione, testosterone and 17-hydroxyprogesterone. Fast progression of pubarche, accelerated growth velocity and advanced bone age should be considered alarm symptoms in patients with premature pubarche.

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