HORMONAL FINDINGS IN AFRICAN-AMERICAN AND CARIBBEAN HISPANIC GIRLS WITH PREMATURE ADRENARCHE - IMPLICATIONS FOR POLYCYSTIC OVARIAN SYNDROME

Background. Premature adrenarche refers to the early maturation of the adrenal zona reticularis such that the resultant modest hyperandrogen ism causes the early appearance of pubic hair before the age of 8 year s in girls and 9 years in boys. The precise etiology of premature adre narche is not known. However, recent studies indicate that certain gir ls with premature adrenarche are at risk of developing functional ovar ian hyperandrogenism, polycystic ovarian syndrome, and hyperinsulinism . Caribbean Hispanic women in general are at increased risk of develop ing polycystic ovarian syndrome, and African-Americans are at increase d risk of developing the complications of hyperinsulinism. Previously, girls with premature adrenarche were reported to have androgens in th e range found in normal children in the early stages of puberty. We no ted that many of our African-American and Caribbean Hispanic patients with premature adrenarche had androgens that were much higher than wha t has been reported previously. Objective. This retrospective study wa s performed to characterize the adrenocorticotropin-stimulated androge n response in an African-American and Caribbean Hispanic population of girls with premature adrenarche. Methodology. The androgen response t o adrenocorticotropin stimulation in 72 African-American and Caribbean Hispanic girls with premature adrenarche was compared with those repo rted for normal girls in early puberty (Tanner stages II and III). The mean age was 6.8 +/- 0.8 years, bone age was 8 +/- 1.5 years, pubic h air was Tanner stages II and III, and body mass index was 18.6 +/- 4. Results. Of the girls, 28% were found to have elevated stimulated 17OH Pregnenolone (17OHPreg) levels that were >2 SD units above the mean fo r normal early pubertal children. The stimulated ratio of 17OHPreg/17O HProgesterone also was elevated in 18% of the girls and showed a modes t correlation with body mass index. Conclusion. In contrast to previou s studies of girls of mixed ethnic backgrounds with premature adrenarc he, 28% of the 72 African-American and Caribbean Hispanic girls with p remature adrenarche had adrenocorticotropin-stimulated 17OHPreg levels that were significantly higher than those seen in early pubertal girl s. Because 17OHPreg hyperresponsiveness has been described previously in women with hirsutism or polycystic ovarian syndrome, the similar fi nding in many African-American and Caribbean Hispanic girls with prema ture adrenarche suggests that the two conditions may share a common me chanism for their hyperandrogenism. Therefore, the hyperandrogenism in certain African-American and Caribbean Hispanic girls with premature adrenarche may not be benign and may be the first presentation of poly cystic ovarian syndrome.