Premature adrenarche and slightly advanced bone age

[justanothermom]

My daughter is 8 (will be nine in 4 months). I recently took her to the pediatrician because I noticed she has underarm hair and some hair in the pubic area. (In case it's noteworthy, I called the ped 15 months ago to see if it was OK for her to wear deodorant because she was very smelly and sweaty under her arms.) The ped said it was premature adrenarche, but just borderline because they really only consider it premature if it's BEFORE age 8 (which of course had me surprised - she only stopped wetting the bed 12 months ago!).

She has no breast development. The bone age came back at 10 years old (about 16 months advanced). The ped has sent a letter to an endocrinologist friend to ask how to proceed. I thought I'd get another opinion here. Do you recommend additional testing? She is 4'4" and weighs about 65 pounds. She has been pretty steady at the 50% for height since birth. I'm concerned that with a bone age of 10, she will end up being even shorter than the 5'3" that was originally predicted (based on her growth curve). I asked the ped about this, but she said she wasn't qualified to answer that question.

I appreciate your time and consideration.

[Deanna L Aftab Guy, MD]

This sounds like premature adrenarche, however with a bone age that is advanced even if her age is not alarming for her physical findings I would consider a small workup. Firstly sometimes the bone age needs read by a pediatric radiologist, next see if the endo will see you, even if they see you themselves in 4 months instead of your pediatrician. Labs that might be helpful will workup for the important causes such as abnormal rise in adrenal hormones, the other concern we have is if these male hormones that are becoming active at a slightly sooner tempo will prime the brain to stimulate the female hormones and trigger true puberty (menses etc).
So labs that are helpful include a 17-OH progesterone, dheas, androstenedione, sometimes thyroid functions and sometimes testosterone (free and total) and at times I get insulin levels since sometimes insulin resistance is a trigger for turning on the steroid production a little early in the adrenal gland-usually seen in obese children, and sometimes premature infants later in childhood due to their adrenals being primed for stress per se!
Bone age should be repeated about every year, monitoring growth is key, if her growth velocity is increasing she may need further testing.

[justanothermom]

Follow up - our pediatrician called and said she'd like to just monitor this for now, and she will check her growth again in 4 months. Is this how you would proceed as well?