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Pediatric Endocrinology (Expert Forum)
Premature Adrenarche
Answered by
Deanna L Aftab Guy, MD - Short Stature, thyroid, Pituitary abnormalit, Puberty concerns, Rapid Growth, Adrenal problems, Parathyroid abnormal, Rickets and bone dis
Vanderbilt Children’s Hospital
Nashville - TN
Questions in the Pediatric Endocrinology forum are answered by Dr. Deanna L Aftab Guy, affiliated with Vanderbilt Children's Hospital. 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.
Premature Adrenarche
by WFE, Jan 31, 2008 06:17PM
My 8-year-old daughter has been diagnosed with premature adrenarche. Her MD says there is no treatment for this but I am wondering if there has been any success treating this with acupuncture or other alternative modalities.
Her only symptom is pubic hair. A few began growing in when she was 7 1/2 and the growth recently started accelerating. She has about 10 hairs there now. She was tested at 7 1/2 for the kind of high adrenal levels that would be caused by a tumor, and she did not have that so her MD ruled out a tumor. She was also tested for high estrogen levels and other hormones that would indicate premature puberty, and those hormones were all normal for her age. She has always been very tall (she is 56" now) and we are concerned that the premature adrenarche will prevent her from reaching her full genetic height. (Her dad and I are both 5' 11" and other family members are also tall). Her hand X-ray when she was 7 1/2 showed she had the bone age of a 10-year-old; her MD said that tall kids usually have an advanced bone age but that hers was probably more advanced because of the adrenal involvement. Please let me know if you know of any alternative therapies; again her MD said there is nothing to be done about this but I am not convinced. Thanks, WFE
Her only symptom is pubic hair. A few began growing in when she was 7 1/2 and the growth recently started accelerating. She has about 10 hairs there now. She was tested at 7 1/2 for the kind of high adrenal levels that would be caused by a tumor, and she did not have that so her MD ruled out a tumor. She was also tested for high estrogen levels and other hormones that would indicate premature puberty, and those hormones were all normal for her age. She has always been very tall (she is 56" now) and we are concerned that the premature adrenarche will prevent her from reaching her full genetic height. (Her dad and I are both 5' 11" and other family members are also tall). Her hand X-ray when she was 7 1/2 showed she had the bone age of a 10-year-old; her MD said that tall kids usually have an advanced bone age but that hers was probably more advanced because of the adrenal involvement. Please let me know if you know of any alternative therapies; again her MD said there is nothing to be done about this but I am not convinced. Thanks, WFE
Doctor's Answer
by Deanna L Aftab Guy, MD, Feb 05, 2008 02:21PM
, Feb 05, 2008 02:21PM
To: WFE
Please do not seek alternative therapy for premature adrenarche, honestly although your pediatrician did an excellent workup with an advanced bone age I would still ask to see a peds endo. Sometimes we need to still proceed with a stim test like an acth stim test or a leuprolide stim test to assess these hormones responses rather than baseline levels. Is she obese? Overweight children make elevated insulin levels and this alone can stimulate the growth plate to mature and the adrenals to become stimulated earlier than other children. He is right in regards to treatment if a cause is ruled out, there is no treatment that is really adequate unless it is due to early puberty or from adrenal hyperplasia(elevated adrenal hormones).
If her bone age is advanced she needs to have it repeated at least yearly, a peds endo needs involved even just for an initial consult.
There may be nothing to be done but the endo needs to make that call, especially with the advanced bone age, I am not worried by the findings or the labs so far, am hoping this is just as we say benign premature adrenarche.
If her bone age is advanced she needs to have it repeated at least yearly, a peds endo needs involved even just for an initial consult.
There may be nothing to be done but the endo needs to make that call, especially with the advanced bone age, I am not worried by the findings or the labs so far, am hoping this is just as we say benign premature adrenarche.
