Adrenarche occurs in children between the ages of six and eight when the adrenal cortex begins to produce larger amounts of androgens in preparation for the onset of puberty. During this time, the adrenal cortex will enlarge and differentiate into three separate sections, each responsible for the production of a specific steroid hormone. Occasionally, a child will begin adrenarche years before the normal age. Excess androgen hormones can cause premature changes to occur in the child’s body.
The onset of adrenarche changes the configuration of the adrenal cortex. Three divisions occur within the body of the adrenal cortex, then each segment produces a different steroid hormone. The zona reticularis begins to generate the androgens, the zona glomerulosa produces the mineralocorticoids, and the zona fasciculata creates the glucocorticoids.
Premature adrenarche, or an early sexual maturation state, is suspected when a child begins to develop some of the physical characteristics of an adult. The first indication is usually an increase in noticeable body odor. Hair may start to grow in the armpits and near the groin. Acne may also begin to develop as androgen production increases.
Children with early and excess androgen production are more likely to have behavioral issues. Boys with premature adrenarche are often more aggressive than other children the same age. Girls and boys with this condition may have trouble fitting in with classmates, and may become depressed or withdrawn.
Research indicates that girls with premature adrenarche are more likely to develop other hormone related disorders later in life. Polycystic ovary syndrome (PCOS) is seen more often among women with a history of early onset adrenarche. These girls are also at a higher risk of fertility problems because of the malfunctioning of the reproductive and endocrine systems.
One of the causes of early androgen production may be weight gain. Overweight children are more likely to be seen by a physician for evaluation of early sexual maturation. Premature androgen development may result in insulin resistance that could lead to diabetes.
Diagnosis of premature adrenarche only requires a short office visit. A physical examination will be performed to confirm the signs of early sexual maturation, and a urine test will be done. Ketosteriods present in the urine often indicate the onset of androgen production.
The recommended treatment of premature androgen production is different from doctor to doctor. Some physicians suggest daily medications to reduce the amount of androgens produced. Cyproterone acetate, ketoconazole, and spironolactone are antiandrogen medications used to treat boys and girls with the condition. Many physicians do not believe the medications are beneficial, and only advise observing the child for the early development of other characteristics of puberty.
