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Lorah D. Dorn, PhD, RN, CPNP; Stacie F. Hitt, PhD, RN; Deborah Rotenstein, MD

Arch Pediatr Adolesc Med. 1999;153:137-146.

Background  Puberty consists of 2 components: gonadarche and adrenarche. Both components have distinct endocrine changes. Adrenarche has virtually been ignored with respect to examining hormone-behavior relations.

Objectives  To provide descriptive biological and behavioral information on children with premature adrenarche (PA) and to examine differences in biological, psychological, and cognitive variables of children with PA and a healthy comparison group of children with on-time adrenarche.

Design  Descriptive pilot study.

Setting  A consecutive sample of patients was recruited from pediatric endocrine clinics; comparison children were recruited from the community.

Participants  Children aged 6 to 9 years. Mean (±SD) age of children with PA (n=9) was 7.8 (±1.3) years; of children with on-time adrenarche (n=20), 8.0 (±1.2) years.

Methods and Measures  Serum and saliva samples were collected for measurement of hormone concentrations. Questionnaires, tests, and interviews were completed by children and parents.

Results  Compared with the on-time group, the PA group had significantly higher concentrations of adrenal androgens, estradiol, thyrotropin, and cortisol. By parent report on the Diagnostic Interview Schedule for Children, 4 children (44%) met diagnostic criteria for psychological disorders (primarily anxiety disorders). The PA group also had more self-reported depression and parent-reported behavior problems and lower scores on various intelligence tests.

Conclusions  Although PA is considered a normal variation of pubertal development that warrants no medical intervention, PA presents with significant psychosocial problems. Children with PA may need psychological evaluation and follow-up. Future studies should confirm these findings with a larger sample and examine the long-term ramifications of this early presenting abnormality.

From the University of Pittsburgh, School of Nursing (Drs Dorn and Hitt), and the Department of Pediatrics, MCP Hahnemann University School of Medicine (Dr Rotenstein), Pittsburgh, Pa.

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