Childhood metabolic syndrome and its components in premature adrenarche

Context: Premature pubarche ( PP), the main clinical manifestation of premature adrenarche ( PA), has been associated with insulin resistance and dyslipidemia in selected populations. Objectives: Our aim was to determine the prevalence of childhood metabolic syndrome ( cMBS) and to study its components in prepubertal Northern European girls with PA. Design and Patients: We conducted a cross-sectional study on 63 prepubertal girls with PA ( 32 with PP = PP-PA, 31 without PP = nonPP-PA) and 80 healthy age-matched control girls. A standard 2-h oral glucose tolerance test with insulin sampling was performed. Plasma lipids and serum SHBG were analyzed, and blood pressure and weight-for-height were recorded. cMBS was defined by modified criteria of the U. S. National Cholesterol Education Project Adult Treatment Panel III and the World Health Organization. Setting: The study was performed at University Hospital. Results: The mean weight-for-height ( P = 0.002) and the prevalence of cMBS by the modified Adult Treatment Panel III ( 24 vs. 10%) and World Health Organization definitions ( 16 vs. 5%) ( P < 0.05 for both) were higher in the PA than control girls. The weight-for-height adjusted serum insulin concentrations during the oral glucose tolerance test were elevated in the whole PA group, whereas the fasting insulin concentrations were increased and SHBG was decreased only in the PP-PA subgroup. The weight-for-height adjusted blood pressure, lipid, or glucose levels did not differ between the study groups. Conclusions: Prepubertal Northern European PA girls have increased prevalence of cMBS mainly due to being overweight and their hyperinsulinism. Among the PA children, the nonPP-PA girls have milder metabolic changes than the PP-PA girls.