Premature adrenarche: findings in prepubertal African-American and Caribbean-Hispanic girls

Premature adrenarche was previously thought to be a benign condition. Howev er, the authors and several other research groups have noted hyperinsulinis m and insulin resistance in many girls with premature adrenarche. African-A merican and Caribbean-Hispanic girls with premature adrenarche are frequent ly obese with marked hyperandrogenism, signs which correlate with the degre e of insulin resistance (i.e., those girls who are obese and insulin resist ant tend to have higher levels of adrenocorticotropic hormone-stimulated an drogens). Also, girls with premature adrenarche and reduced insulin sensiti vity can have subtle decreases in their high-density lipoprotein (HDL) prof ile. Many of these girls have a strong family history of type 2 diabetes me llitus. Preliminary data regarding long-term follow-up of girls with premat ure adrenarche indicate that those girls who remain obese are at risk of de veloping polycystic ovary syndrome (PCOS). The term 'syndrome X' refers to the constellation of laboratory and clinical findings associated with hyper insulinism stemming from insulin resistance. These findings include obesity , acanthosis nigricans, glucose intolerance, type 2 diabetes mellitus, dysl ipidaemia with reduced HDL and elevated low-density lipoprotein, cardiovasc ular disease and PCOS. Hence, for certain girls, premature adrenarche may b e a part of the clinical spectrum of syndrome X.