Definition of Adrenarche
Adrenarche is the gradual increase in adrenal androgen secretion after approximately the age of 6 years in girls and 7 years in boys. It occurs independently from the gonadotrophin-dependent activation of the gonads in central puberty.
Clinical Significance
Adrenarche is a normal variant of pubertal development. There has been previous concern that adrenarche may be associated with the development of insulin resistance, polycystic ovarian syndrome and metablic syndrome, but this does not alter management or follow up.
Adrenarche
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Note that this email address contacts the team managing the website rather than the service itself; as such, please do not reach out with clinical queries or concerns.
Introduction
Initial Management
This guidance applies to children with signs of adrenal hormone secretion, i.e pubic hair growth, body odour, greasy skin, but NO breast development in girls or testicular enlargement in boys. The latter are suggestive of gonadotrophin driven pubertal development and depending on the age of the child, may justify further investigations.
Assessment should include: history of growth acceleration with plotting of height on growth chart, ideally plotting of both parents’ height and clinical examination for signs of pubertal development.
Assessment should include: history of growth acceleration with plotting of height on growth chart, ideally plotting of both parents’ height and clinical examination for signs of pubertal development.
Who to Refer
The following pathway gives more detailed guidance on differentiating children with simple adrenarche from those with pathological androgen excess or precocious puberty:
Tayside precocious puberty/adrenarche pathway
Please refer any child with concerning features to paediatric endocrinology via SCI gateway.
Tayside precocious puberty/adrenarche pathway
Please refer any child with concerning features to paediatric endocrinology via SCI gateway.
Who Not to Refer
Girls > age 8 and boys > age 9 with symptoms of adrenarche only.
Useful Resources
The Scottish paediatric endocrine group website contains useful SPEG parent information leaflets, including for adrenarche:
RCPCH Growth Charts
RCPCH Growth Charts