6 yr old Not sure whats wrong please help!

[lilly2008]

This is being posted under adrenal problems but we have no idea whats going on. My son just turned 6 about 3 months ago. He started having adult body odor wihtout regular daily baths when he was 5. By regular I mean every day. My children receive a bath everyother day when they are not playing outside! We didn't think much of the body odor but to wash him more frequently. 3 month before he turned 6 (this past sept 30) my husband noticed he started having some spars pubic hairs goring. We honelstly did not think much of it. We brought him to the dr for an unrelated cause and the ped had mentioned we should have looked at by a pediatric endo. Which we did right away. The ped endo ran a battery of tests and said all the tests came back normal (i hape copies). And also said the hand bone age was normal as well, She wants to put him in for a mri with and without contrast and with sedation, I realize the procedure is sae but what else can be done before going to this costly level. This is going to cost my family about 2,000$ oop was the estimated cost. COuld be more or less they told me. WHAT ARE TEST CAN BE RUN ON THS LITTLE GUY THAT ARE NT SO INVASIVE (IE WITH CONTRAST)
tEST RUN
acth-ICMA 9.1   referene range 6-4
IGF-I(BL) age  rane 60-228  mean 116
luteinnnnizng hormone0.04 result

[Deanna L Aftab Guy, MD]

Body odor and pubic hair describe premature adrenarche or early production of the adrenal hormones that are normal in our bodies, what we need to rule out is an abnormal production of these hormones due to tumor, or an enzyme block such as in congenital adrenal hyperplasia or early puberty perhaps.
So if his hormones were fine and his bone age was not advanced I am very confused why they want an mri, here is why I am confused, the adrenal gland makes a bunch of hormones that contribute to our secondary sexual characteristics like body odor, curly hair in the pubic and axillary area and acne, but also can stimulate rapid growth hence the bone age assessment.
Puberty itself is related to the pituitary, this presents with testicular enlargement and penile enlargement at times, this is early puberty and not necessarily caused by the adrenal problem, this needs an mri of the pituitary, not an isolated adrenal problem.
His labs that you have provided are normal but not complete
workup for adrenarche includes 17-OH progesterone which is the hormone that is very very elevated with the enzyme block problems of congenital adrenal hyperplasia, also dheas and androstenedione, which will show mild elevation in benign adrenarche but very high elevations should something else be wrong.
A bone age is also helpful and not advanced is a good thing.
maybe an ultrasound of the adrenal gland may help.
You need to sit down with this peds endo and discuss what their thoughts are. He is 6, an early age for adrenarche, but if he is african american or hispanic this leads to a little earlier surge of the normal adrenal hormones but not progression. If he is overweight this too can contribute some and if he was premature for some reason this too can lead to an earlier rise in these normal hormones.
The thing we worry about in boys is if we also find enlargement of the testes then we worry about the pituitary or other source of male hormones.
So go back to your ped endo and set up a conference with your husband and sit down and go over all the labs and what is really necessary, If they found nothing other than a little pubic hair and the bone age is not advanced, it is not unreasonable to monitor him every 4-6 months for growth spurts, change in exam or change in his bone age.(I usually don't get repeat bone ages any more frequent than 6 months apart if that)
Talk with them. Get this cleared up, the cost is too much for you to take on without a clear need

[lilly2008]

thank-you i received a cancellation call with another ped endo and have a appt next week to see someone else. I spoke with the ped endo referenced above and she was very short and unpleasant on the phone. She said no need to make an appt and come back in again, her suggestion is for the mri but could give me no insight into why. I am not a Dr, but I am a college educated person that does work in the pharma arena. I just do not specialize in ped drugs or scientific work involving children. THANK-YOU SO MUCH, You have been extremely helpful and have also reinforced for me that I definately should go for a second opinion.You offered a short concise way to help explain to me whats going on. My Sons current dr could have accomplished this in 15 seconds but did not take the time to do so or maybe didn't think we were smart enough to understand. thanks again

[Deanna L Aftab Guy, MD]

You are very kind, thanks and hope that the next doc is helpful