Endocrine Abstracts

Context: The early activation of adrenal zona reticularis, denoted by increased circulating levels of adrenal androgens before the age of eight years in girls is called premature adrenarche (PA), while the concomitant appearance of pubic hair is termed premature pubarche (PP). Girls with PA-PP display an unfavorable metabolic, hormonal and psychologic profile, compared to their normal peers and are also at an increased risk of developing polycystic ovary syndrome (PCOS) features peripubertally, especially those born small for gestational age. The natural history of these girls with PA-PP post puberty is unclear.

Aim of the study: To define the metabolic, hormonal, and psychologic profile of young lean women with a history of both PA and PP, born with a normal birth weight. These women were prospectively followed since childhood, did not seek medical assistance and their majority did not fulfill PCOS criteria.

Participants: 21 PA-PP women (age: 21.35±3.36 years, BMI: 23.59±4.40kg/m²) were compared with 26 controls and 45 women with classic PCOS. Only three women (14%) in the PA-PP group had PCOS by the Rotterdam criteria.

Results: PA-PP women had significantly lower serum total cholesterol (165±20 vs. 187±28 mg/dl), LDL (87±21 vs. 21±12mg/dl) and higher HDL (65±11 vs. 56.2±10.9mg/dl) than controls. Insulin resistance index HOMA-IR was similar in PA-PP (2.09±1.42) and PCOS (2.08±0.83), and significantly higher than that of controls (1.13±0.49). Serum delta 4-androstenedione levels (ng/ml)did not differ between PA-PP (3.22±1.44) and PCOS (3.54±1.14) but were significantly higher than controls (0.58±1.42). Similar findings were obtained for DHEAS and 17OHP, however serum testosterone and free androgen index were comparable among all groups. Ovarian volume (cm³) was similarly increased in PA-PP (11.14±3.34) and PCOS (10.99±4.61) compared to controls (6.74±1.83). Regarding their psychologic profile, PA-PP women had a significantly higher score of state and trait anxiety, as well as of depressive and eating disorder symptoms than controls, with a pattern that was quite similar to that of PCOS.

Conclusions: Young lean women with a history of PA and PP displayed hormonal, metabolic and psychologic profiles similar to those of their peers with classic PCOS. These findings indicate that in women with PA-PP history, a thorough evaluation and long-term monitoring is needed.