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- 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
- 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.