HYPERINSULINEMIA, DYSLIPAEMIA AND CARDIOVASCULAR RISK IN GIRLS WITH AHISTORY OF PREMATURE PUBARCHE

Girls with a history of premature pubarche, i.e. appearance of pubic h air before 8 years of age, show hyperinsulinism in response to an oral glucose tolerance test. As hyperinsulinaemia has a major role in dysl ipaemia, and is considered an independent risk factor for cardiovascul ar disease, we assessed the patterns of plasma insulin concentration a fter a standard oral glucose tolerance test as well as fasting serum l ipid, lipoprotein. and sex hormone-binding globulin concentrations in girls (n = 81) with premature pubarche compared with girls (n = 55) ma tched with them for stage and bone age to ascertain their metabolic st ates to identify those potentially at risk for the development of prem ature cardiovascular disease. Mean serum insulin concentrations were h igher in patients at all pubertal stages, and associated with elevated serum triglyceride, very low density cholesterol and very low density triglyceride concentrations (p value range 0.04 to < 0.0001) but redu ced sex hormone-binding globulin. Premature pubarche patients also dis played higher low density to high density lipoprotein cholesterol rati os compared with control subjects (p = 0.004 to 0.008). In conclusion, hyperinsulinaemia, decreased sex hormone-binding globulin concentrati ons and an unfavourable lipid pattern are common features in premature pubarche girls supporting the contention that atherogenic abnormaliti es composing the metabolic syndrome could start in childhood. To deter mine the clinical sequelae of such clustering of metabolic deviations, girls who were identified need to be followed up for the potential de velopment of premature cardiovascular disease.