PRECOCIOUS PUBARCHE, HYPERINSULINISM, AND OVARIAN HYPERANDROGENISM INGIRLS - RELATION TO REDUCED FETAL GROWTH

Pronounced adrenarche with precocious pubarche (PP) in girls has been associated with hyperinsulinism and subsequent functional ovarian hype randrogenism (FOH). Recently, pronounced adrenarche and insulin resist ance have each been related to low birth weight. We have now tested th e hypothesis that the frequent concurrence of PF with pronounced adren arche, FOH, and hyperinsulinemia in girls may be secondary to separate relationships between these conditions and low birth weight. A total of 185 girls (aged 5-18 yr) without endocrinopathy or with PP and pron ounced adrenarche Kith or without FOH were studied; mean serum insulin (MSI) concentrations were determined after a standardized oral glucos e tolerance test. Birth weight so scores [mean (SEM)] of control girls (0.38 +/- 0.08; n = 83) were higher (P < 0.0001) than those of PP gir ls ( -0.81 +/- 0.13; n = 102). Among postmenarcheal PP girls, birth we ight sn scores of girls without FOH (-0.25 +/- 0.19; n = 25) were high er (P < 0.0001) than those in girls with FOH (-1.51 +/- 0.28; n = 23). In pubertal girls (n = 145), MSI levels correlated negatively with bi rth weight so scores (r = -0.48; P < 0.05), independently of PP. MSI l evels in girls with birth weight below 1 sn (93 +/- 9 mU/L; n = 33) we re higher (P < 0.0001) than those in girls with birth weight between - 1 and +1 so (52 +/- 2 mU/L; n = 94), whereas glycemia profiles were co mparable. Integration of the aforementioned data suggests that there m ay be a sequence in the associations between reduced fetal growth and components of the postnatal endocrine system; minor fetal growth reduc tion appears to be associated with amplified adrenarche, whereas more pronounced prenatal growth restriction seem to precede FOH and hyperin sulinemia during adolescence. In conclusion, these findings corroborat e the hypothesis that the frequent concurrence of Pr (with pronounced adrenarche), FOH, and hyperinsulinemia in girls may result from a comm on early origin (low birth weight serving as a marker), rather than fr om a direct inter-relationship later in life.