Influence of Premature Adrenarche and Obesity on Skeletal Maturation and Predicted Adult Height

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 596-621-Pediatric Endocrinology /Steroids and Puberty
Clinical
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-609
Shilpa Gurnurkar*, Kristopher Arheart, Sarah E Messiah, Aimee Mankodi and Adriana Carrillo-Iregui
University of Miami, Leonard M. Miller School of Medicine, Miami, Florida
Introduction and Objective:  Premature adrenarche (PA) is defined as the appearance of pubic and/or axillary hair before the age of 8 in girls and 9 in boys in the absence of signs of gonadal maturation such as breast development and testicular enlargement.  It has been historically assumed that PA was a benign, normal variant of puberty without long term consequences or effect on final height but this belief has recently been challenged. Both obesity (common in PA-diagnosed children) and PA are frequently associated with an advanced bone age, yet a possible causative mechanism is largely unknown [1,2,3]. Additionally, the influence of advanced bone age on predicted adult height remains controversial. Very little is known on this topic among US pediatric patients and those of Hispanic origin in particular [1,3,5]. The objective of our analysis was to explore the relationship between PA, body mass index (BMI), bone age advancement, and their synergistic effect on predicted height among a unique ethnic group of children originating predominantly from South and Central America and the Caribbean Basin followed clinically for premature adrenarche.

 Design and Methods. A retrospective chart review identified 100 children previously diagnosed with PA (65 girls, 35 boys) from one pediatric endocrinology clinic.

 Results. The majority of the sample was Hispanic (65%) and twice as many boys versus girls were obese (62.8% vs. 32.8%). Over one quarter (28.2%) of the sample had systolic blood pressure (BP) >90%ile and 9.7% had diastolic BP >90%ile. The majority of subjects (89.2%) had an advanced bone age and of this group, 71.4% had a bone age > 2 standard deviations (SD) above the mean. There was a significant correlation between BMI and bone age advancement (r=0.67, p=<0.0001) and 41.8% had a predicted height below target (70.8% of whom had a predicted height > 2 inches below target). The majority (72.7%) of the subjects with a sub-optimal predicted height had a bone age advancement of 2 SD or more. There was a significant correlation between DHEA-S and bone age advancement (r=0.34, p=0.01).

 Conclusions: Our findings support previous reports that obesity is an important contributor to rapid skeletal maturation and thus bone age advancement [1,5,6,7]. Analysis showed that PA and obesity have a synergistic effect on skeletal maturation and that significant bone age advancement in PA predicts a sub-optimal adult height. To our knowledge, this is the first analysis in the field demonstrating a negative effect of PA and bone age advancement of > 2 S.D on predicted height among a predominantly Hispanic patient sample. Although large, prospective studies that follow subjects with PA until completion of growth are needed to confirm these findings, our results suggest that premature adrenarche is not a benign condition and that children who are obese and have an advanced bone age need to be carefully managed over time.

1. Sopher AB, Jean AM, Zwany SK et al. Bone age advancement in prepubertal children with obesity and premature adrenarche: possible potentiating factors. Obesity 2011; 19 (6):1259-1264.2. Ibañez L, Virdis R, Potau N, Zampolli M, Ghizzoni L, Albisu MA, Carrascosa A, Bernasconi S, Vicens-Calvet E. Natural history of premature pubarche: an auxological study. J Clin Endocrinol Metab. 1992 ;74 (2):254-2573. Von Oettingen J, Sola Pou J, Levitsky LL, Misra M. Clinical presentation of children with premature adrenarche. Clinical pediatrics 2012; 51(12) 1140-11494. Ibáñez L, Dimartino-Nardi J, Potau N, Saenger P. Premature adrenarche- Normal Variant or Forerunner of Adult Disease. Endocr Rev. 2000; 21(6): 671-696.   5. Diaz A, Bhandari S, Sison C, Vogiatzi M. Characteristics of children with premature pubarche in the New York metropolitan area. Horm Res 2008; 70:150-154.6. Charkaluk ML, Trivin C, Brauner R. Premature pubarche as an indicator of how body     weight influences the onset of adrenarche. Eur J Pediatr 2004; 163 (2):89-93.7. de Ferran K, Paiva IA, Garcia Ldos S, Gama Mde P, Guimaraes MM. Isolated premature pubarche: report of anthropometric and metabolic profile of a Brazilian cohort of girls. Horm Res Paediatr. 2011; 75 (5):367-373.

Nothing to Disclose: SG, KA, SEM, AM, AC

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