Interrelationship of Extent of Precocious Adrenarche in Appropriate for Gestational Age Girls with Clinical Outcome

Objective To assess the interrelationship between extent of adrenarche at presentation in girls with precocious adrenarche (PA) born appropriate for gestational age and their growth pattern, pubertal course and adult height. Study design We reviewed clinical and laboratory data from medical charts of 85 girls with PA aged 5.0 to 8.8 years at referral, stratified in 3 subgroups according to bone age (BA) minus chronological age (CA) <= 0 years; 0 < BA minus CA < 1 year; BA minus CA > 1 year. Results Extent of pubarche and dehydroepiandrosterone-sulfate levels were greatest in the BA - CA > 1 subgroup (P = .02, P = .008, respectively), who also were taller at diagnosis (P = .002) and during childhood (P = .01). In all subgroups, pubertal onset was within normal range; menarche occurred earlier than in control subjects (P < .02); all attained adult height within their mid-parental height range. Predicted adult height was overestimated in girls with BA <= CA (P = .04) and underestimated with BA - CA > 1 (P < .001). Conclusions Although a more pronounced adrenarche and BA advancement at diagnosis in girls with PA born appropriate for gestational age had an impact on their pre-pubertal growth pattern, it was not associated with early and rapid progression of puberty or reduced adult height. This reassuring clinical course indicates that PA is a benign condition, irrespective of the extent of adrenarche at presentation. Adult height prediction is unreliable in PA. (J Pediatr 2012; 160: 308-13).