Premature Adrenarche



  • Appearance of pubic hair before age 8 years in girls and age 9 years in boys with elevated adrenal androgens (dehydroepiandrosterone [DHEA] or dehydroepiandrosterone-sulfate [DHEA-S])
  • Some data suggest that the age of normal sexual development onset in girls is younger than previously recognized, but lowering of the traditionally accepted limits remains subject to debate.
  • Axillary hair, acne, and apocrine sweat gland secretion are not always present with premature adrenarche.
  • No other signs of sexual development should be present.
  • Presence of breast development in girls or testicular enlargement in boys suggests precocious puberty and not premature adrenarche.
  • Occurs independently of hypothalamic–pituitary–gonadal axis activation seen with true puberty

Risk Factors


  • Often sporadic
  • Familial patterns suggesting recessive and dominant inheritance have been described.


  • Concentrations of adrenal steroids such DHEA or DHEA-S increase earlier than typically seen in normal puberty.
  • Note: Zona reticularis of adrenal normally begins to increase androgen secretion at age 6 to 8 years.

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