Endocrinology and metabolism after premature pubarche in girls

The prevalence of functional ovarian hyperandrogenism, hyperinsulinism and dyslipidaemia is increased in adolescent girls with a history of premature pubarche, defined as the appearance of pubic hair before the age of 8 years . The ovarian hyperandrogenism is characterized by clinical signs of androg en excess and an exaggerated ovarian 17-hydroxyprogesterone response to gon adotrophin-releasing hormone agonist stimulation. The hyperinsulinism and d yslipidaemia are detectable before and during pubertal development, and the y are commonly accompanied by low serum levels of insulin-like growth facto r binding protein-1 (IGFBP-1) and sex hormone binding globulin, and by an i ncreased prevalence of anovulation from late adolescence onwards. In girls, premature pubarche, hyperinsulinism, low serum levels of IGFBP-1, dyslipid aemia, anovulation and hyperandrogenism (or various combinations of these c onditions) have been related to reduced fetal growth, indicating that these constellations or sequences may have a prenatal origin. These findings sug gest that premature pubarche in girls should no longer be regarded as merel y a normal variant of development, but rather as a childhood marker pointin g to an increased risk of a polyendocrine-metabolic disorder of prenatal or igin.