ESPE Yearbook of Paediatric Endocrinology

Brief summary: In this cross-sectional study, the growth pattern from birth until diagnosis of premature adrenarche (PA) was assessed in 82 children (16 boys) compared to 63 controls (15 boys). PA children were taller, heavier and had an accelerated linear growth. PA children also showed earlier adiposity rebound (AR) irrespective of whether they had obesity or not. A sex dimorphism was observed. The authors hypothesized that both earlier AR and accelerated linear growth may trigger adrenal androgen production and PA.

Adrenarche remains a poorly understood developmental event. Neither its normal regulation, nor its disease-related relevance when occurring too early, are understood. Several studies (including this one) describe significant differences in clinical and biochemical characteristics of PA compared to normal-timed adrenarche. As several studies also find a correlation of PA with later adverse outcome concerning metabolic and reproductive disorders, it is important to put all possible effort in research to understand the regulation of normal adrenarche and the pathogenesis underlying PA. We need to understand in order to be able to treat and prevent as necessary.

This descriptive study clearly shows that PA is not (only) the result of early childhood obesity. It also shows that the growth pattern of PA is different long before the diagnosis is made; it is in fact already visible by an earlier AR. Whether this is an early sign of the underlying “disease” or in fact the trigger of PA remains an open question.

Ze’ev Hochberg was very much interested in the infancy-childhood-adolescence transition events and underlying mechanisms (1-3). He suggested that the AR may be the first sign of juvenility or the signal that turns on the transition from childhood to juvenility.

References: 1. Hochberg Z. Evo-Devo of Child Growth: Treatise on Child Growth and Human Evolution. (Book). Wiley-Blackwell; 1st edition (18 Oct. 2011). ISBN-13 978-1118027165. 2. Hochberg Z. Evo–devo of child growth II: human life history and transition between its phases. European Journal of Endocrinology. Feb 2009;160(2):135–141. doi.org/10.1530/EJE-08-0445. 3. Hochberg Z. Evo-devo of child growth III: premature juvenility as an evolutionary trade-off. Horm Res Paediatr. 2010;73:430–437. DOI: 10.1159/000282109.