Premature Adrenarche

Adrenarche is a lot like puberty; it’s characterized by changes in the body as your child enters her teen years. Premature adrenarche is when these changes begin early, before age 8 for girls and age 9 for boys. It’s usually nothing serious, simply your child’s body maturing in its own time.

It may be helpful to think of puberty and adrenarche as separate processes that your child’s body goes through, usually at the same time, but not always.

• Adrenarche means “the awakening of the adrenal gland.” The adrenal gland is responsible for making hormones including androgens — sex hormones that cause changes such as the development of pubic hair, oily skin, oily hair, and body odor. There is one adrenal gland on top of each kidney.
• Puberty is the name given to the stage of life at which the body becomes capable of sexual reproduction. During puberty, the brain sends signals to glands in the testes for boys and ovaries for girls, spurring the development of sperm, eggs, and other secondary sexual characteristics (such as breasts for girls and a deepening voice for boys).

While an earlier onset of adrenarche is usually normal and not a cause for concern, there is the possibility that it could indicate an underlying enzyme problem or a tumor. That’s why it’s a good idea to consult a professional if your child shows symptoms of adrenarche before age 8 for girls and age 9 for boys.

Premature adrenarche is caused when the adrenal gland begins secreting sex hormones called androgens earlier than normal. In most cases, it’s not that more androgen is being made, it’s that the standard amount is being made earlier than normal. That means that in most cases, the effects of adrenarche are not exaggerated (your child won’t be hairier than her peers), the effects simply appear sooner.

It’s not known what causes the adrenal gland to begin secreting androgens early. Since exposure to these hormones causes premature adrenarche, your child may also experience it if she comes in contact with hormone creams or other hormonal medications.

If your child is showing symptoms of premature adrenarche, her healthcare provider may want to simply monitor it for a while with regular checkups. Other diagnostic procedures may be performed to rule out causes and complications. These could include:

• Monitoring your child’s growth patterns to see if she is growing at a steady rate
• Bloodwork to measure hormone levels
• X-ray of your child’s hand to determine “bone age,” which can indicate early puberty

Premature adrenarche doesn't require treatment. However, it will cause your child's body to change sooner than those of her peers, and this may make her feel self-conscious.

It's important to reassure her that the changes in her body are completely normal, even if she is experiencing them earlier than other children. Helping your child cope with teasing from her peers, treating her appropriately for her age and boosting her self-esteem are all important ways of helping her adjust well.

Caring for more than 7,000 patients each year, Boston Children Hospital’s Division of Endocrinology is one of the largest pediatric endocrinology practices in the country. In addition to offering expert consultation, our experienced, multi-disciplinary staff provides specialty care for children and adolescents with a variety of medical problems and issues, including premature adrenarche.