Article
Adrenarche
Adrenarche is the early developmental phase (typically ages 6–10) during which the adrenal zona reticularis matures and production of adrenal androgens (DHEA, DHEAS, androstenedione) increases. It precedes true gonadal puberty (gonadarche) and is biochemically distinct.
Features
- Rising serum DHEA and DHEAS.
- May produce early signs: body odor, mild oily skin, occasional early pubic or axillary hair (termed premature adrenarche if before age ~8 in girls) without breast development.
- Does NOT involve activation of the hypothalamic–pituitary–gonadal (HPG) axis.
Physiology
Maturation of adrenal enzymes (e.g., 17,20-lyase activity of CYP17A1) increases androgen precursor synthesis. These weak androgens can convert peripherally to more potent androgens or estrogens.
Clinical Distinctions
- Premature adrenarche must be differentiated from central precocious puberty (which shows breast development and advanced growth velocity). Bone age may be mildly advanced but usually benign.
- Persistent virilization (clitoromegaly, rapid growth, severe acne) warrants evaluation for non-classic congenital adrenal hyperplasia or tumors.
Relevance to Puberty
Adrenarche can overlap with early psychosocial changes and sets the stage for later pubarche. See puberty, pubarche, gonadarche.