Paterson WF, Ahmed SF, Bath L, Donaldson MD, Fleming R, Greene SA, Hunter I, Kelnar CJ, Mayo A, Schulga JS, Shapiro D, Smail PJ, Wallace AM
Exaggerated adrenarche in a cohort of Scottish children: clinical features and biochemistry. [JOURNAL ARTICLE]
Clin Endocrinol (Oxf) 2009 Oct 26.
SUMMARY
Objective: To investigate the reported association between exaggerated adrenarche (EA) and reduced fetal growth and to identify possible risk factors for future morbidity in Scottish children with clinical features of EA.
Design: Three-year prospective study. Measurements: Auxology; blood pressure (BP); biochemical analysis of blood and urine; pelvic ultrasound in girls.
Results: Fifty-two patients were recruited of whom one girl had non-classical congenital adrenal hyperplasia (17-OHP 17 nmol/l) and one had insufficient blood for analysis. The final cohort comprised 42 girls of mean (SD) age 7.7 (0.99) and 8 boys of 8.8 (0.67) years. Mean (SD) birth weight was 3.27 (0.49) and 3.10 (0.76) kg in girls and boys, respectively. Height/weight SDS were 1.13/1.69 in girls and 1.69/1.88 in boys. Mean systolic/diastolic BP was 107.8/60.4 (50(th)-75(th) centile) in girls and 115.5/63.9 (75(th)-91(st) centile) in boys. Uterine and ovarian development were pre-pubertal. Median serum DHEAS was 2.1 and 4.1 mumol/l, androstenedione 3.1 and 3.8 nmol/l in girls and boys, respectively, with DHEAS within the reference range/undetectable in 18/2 and androstenedione in 12/6 patients. Fasting insulin was 9.0 and 15.0 mU/l in girls and boys, respectively, with concomitant low normal SHBG. Anti-Mullerian hormone (AMH) was 15.7 pmol/l in 27 girls, compared with 5.0 pmol/l in normal girls aged 5-8 years. .
Conclusions: Our Scottish EA cohort showed female predominance, no evidence of reduced fetal growth, a tendency to overweight with commensurate mild hyperinsulinaemia and modest elevation of serum androgens in some patients. We have found raised AMH levels in the girls, indicating advanced ovarian follicular development.
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