Sex

Benign Premature Adrenarche

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Benign Premature Adrenarche, Premature Adrenarche

  • See Also
  1. Precocious Puberty
  2. Precocious Puberty Causes
  3. Benign Premature Thelarche
  4. Sexual Development
  5. Male Tanner Stage
  6. Female Tanner Stage
  • Pathophysiology
  1. Benign self-limited cause of Precocious Puberty
  2. Results from adrenal androgen release as opposed to the pubertal Hypothalamus-Pituitary-Gonadal activation
  • Epidemiology
  1. Onset before age 6 years
  • Signs
  1. Normal linear growth pattern
  2. Early secondary sexual characteristics in children
    1. Early pubic hair and axillary hair development
    2. Increased sebaceous activity
    3. Adult-type body odor
    4. Mild acne
  3. No Sexual Development
    1. No penis or Testes enlargement
    2. No Breasts, clitoris or ovary enlargement
  • Differential Diagnosis
  1. See Precocious Puberty Causes
  2. Congenital Adrenal Hyperplasia
  3. Cortisol excess
  4. Adrenal tumor
  • Imaging
  1. Bone Age consistent Chronological Age
  2. Other imaging studies normal
  • Labs
  1. Labs may be deferred initially
  2. Slight increase in Serum Dehydroepiandrosterone (DHEA) level
  3. Other adrenal steroid Hormones normal (e.g. Cortisol, Aldosterone)
  4. Sex Hormone levels normal (Estradiol, Testosterone)
  5. Normal Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH)
  6. ACTH Stimulation Test normal
    1. No Congenital Adrenal Hyperplasia
  7. GnRH Stimulation Test normal
    1. Consistent with prepubertal pattern
  8. 17-Hydroxyprogesterone
    1. Elevated in <5% of cases (due to mild congeital adrenal hyperplasia)
  • Management
  1. Reassurance
  2. Indications for pediatric endocrinology
    1. Pathologic adrenal causes suspected (esp. age <6 years)
    2. Virilization
    3. Associated other signs of pubertal development
    4. Increased Growth Velocity
    5. Advanced Bone Age
  • References
  1. Brown (2025) Am Fam Physician 112(5): 513-21 [PubMed]
  2. Klein (2017) Am Fam Physician 96(9): 590-99 [PubMed]