Premature Adrenarche with elevated bone age

During our yearly physical, my 8 year old son's, pediatrician noticed puberty hair and suggested we see an Endo and gave me a diagnosis of precocious puberty. This was a pediatrician that was available at the same office.  He sent us to get a bone age, his bone age shows that of age 10 to 11.  Today we met with our regular pediatrician and he felt that it might be premature adrenarche.  He didn't realize a bone age was done.  He stated that based on the fact that my son's testicles are of normal size, he doesn't have acne or voice deepening, that he woul have lab drawn to check the elevations.  He said he can usually tell once the lab results are back.  However, he said that he'd have to consult with the endo, once the lab results came back.  Once the lab is drawn if the levels are not that of precocious puberty, he'd still want to check to see if we need to see an Endo because of the elevated bone age.  He stated that he doesnt usually order bone age, unless the levels are elevated that show precocious puberty.  Is it common for children to have premature Adrenarche with an elevated bone age?  I'm about 5"7" my husband is 5"11.  My dad is 6'3 and his dad was tall as well. My son doesn't appear any taller than any of his pears.  He his of normal weight of about 68 pounds. Does height or family history have anything to do with having an elevated bone age.  Any advice you can provide is appreaciated.

[Deanna L Aftab Guy, MD]

I agree with the very careful followup plan, this is exactly what I would do. I see my kids every 4 months even if we think it is premature adrenarche and labs are all good and Yes some of our benign premature adrenarche kids can have advanced bone age, the goal is a few things, firstly be sure that this is not due to an unusual reason, second be sure that this benign thing does not then turn on early puberty which your pediatrician correctly described to you-testicular size NOT pubic hair (hair is from adrenal hormones produced once the adrenal gland matures around age 6-8 in some kids or a little later in others) puberty in boys is from the brain signalling to the testes leading to elevated testosterone and penis and testicular enlargement.
If he is overweight this may contribute, if he was premature these kids have jumpy adrenal glands that mature a little sooner but do well otherwise or it can just be genetic, if there is African American, Latin American or Middle Eastern and lately I have seen many Irish and Scottish decent patients that have a family tendency to have earlier more abundant hair growth. Now once the labs rule things out the peds endo and or your pediatrician need to see him about every 4 months to measure his height velocity, get a yearly bone age and check for any rapid changes. Most of the times as long as you manage his weight well, the bones remain the same or rather mature slower than the child's age progresses and there is some "catch up" making final predicted height better. With you being 5'7" (tall for a woman) and Dad being 5'11" your midparental height is about 6'1. So as long as his bone age projects him to be within the range for his genetic potential this is also good news. Keep following up with this team, they are on top of things.

[Margaret723]

A related discussion, Premature Adrenarche in Boys was started.