Pediatric Endocrinology Expert Forum
pubic hair on infant
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Questions in the Pediatric Endocrinology forum are answered by Dr. Deanna L Aftab Guy. Topics covered include adrenal problems, diabetes insipidus, menstrual irregularities, obesity, parathyroid abnormalities, pituitary abnormalities, puberty concerns, rapid growth, rickets and bone disease, short stature, and thyroid.

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pubic hair on infant

Hi.  My daughter, age 13 months, developed very slight pubic hair growth beginning (we think) around 8 months.  She was born prematurely at 33 weeks and did gain weight very rapidly in the first 6 months.  She is now 23lbs, in the 75-90th percentile for both height and weight.  She also has reactive airway disease and is on nebulizer treatments of pulmicort and albuteral as needed.  She used the pulmicort regularly throughout the winter months.  She was referred to a pediatric endo and bone age and blood work were normal.  He is calling it premature adrenarche.  We will be following up with their office regularly to watch her growth.  

My questions: 1) have you had experience with pubic hair growth in infancy caused by inhaled steroids?  Is this even possible?   2) the cases of premature adrenarche I've read about in journals have been of 5-7 year old girls, not infants.  Does the fact that these symptoms are appearing so early for my daughter suggest that she will have ongoing or more serious adrenal problems later in life?  3) what other things should we be monitoring for as she grows?  How often should bloodwork be done?

Thank you for your help!  I'm new at all this, and it's pretty overwhelming!  
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Answers to your questions and do NOT take advice from anyone except your peds endo!
1-I have indeed seen pubic hair in infants this young but not truly able to say it was from the steroids, I have had one patient on a medication used for infantile spasms that caused such a high level of cortisol in her system that now that she is off of medication the left over results is a little pubic hair from stimulation to the adrenal glands.

2-premature adrenarche, the early production of the normal what I term male hormones from the adrenal glands, DHEAS, androstenedione  when they are produced early or in excess it is important to rule out abnormal reasons.  A bone age under age 2 is hard to interpret so yearly bone ages will let us know if the bones are indeed exposed to excess levels of these hormones. One important cause that is rare and often screened for at birth is congenital adrenal hyperplasia, this is a block in the enzymes that the adrenal glands make and there is a build up of the male hormones that then cause the hair to become coarse and curly in the pubic and axillary area and cute baby sweat to change to  body odor. There is a nonclassical kind that may not show till later after birth due to an incomplete block, this needs to be ruled out, if all is well and there is just an early blip of these normally occuring hormones then they can monitor her closely to be sure that things do not advance to stimulate the pituitary to trigger the female hormones associated with early puberty as we know it. The method used to test is an acth stim test. If this is normal then you have your diagnosis-sometimes in the premie babies their adrenals are so primed from all the stress per se that they put out a blip of these hormones early and the body shows the physical response, usually this does not progress and does not mean early puberty per se.
3-I see my kids every 4 months, if stable then every 6 months, if acth stim was normal then about every 6-8 months since I know the serious stuff is ruled out.

Hope this helps, sounds like your endo is on top of this!
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