Pre- and postpubertal findings in premature adrenarche

The complications of hyperinsulinism and insulin resistance are becoming mo re common in pediatrics (including type 2 diabetes mellitus, dyslipidemia a nd polycystic ovary syndrome) because of the increased occurrence of obesit y in children, We report the occurrence of insulin resistance and marked hy perandrogenism in prepubertal minority group girls (African-American and Ca ribbean Hispanic) with premature adrenarche. Approximately one-third of our prepubertal patients with premature adrenarche evaluated have been noted t o have marked hyperandrogenism. with ACTH stimulated levels of 17-hydroxypr egnenolone and the ratio of 17-hydroxypregnenolone/17-hydroxyprogesterone m ore than two standard deviations above the mean of normal early pubertal gi rls (Tanner II-III), Furthermore, those girls with the more marked hyperand rogenism have been noted to have insulin resistance as assessed by the freq uently sampled intravenous glucose tolerance test, A preliminary evaluation of adolescent girls previously evaluated for premature adrenarche has reve aled that those girls with hyperandrogenism and insulin resistance when eva luated in the prepubertal period continue to have obesity, insulin resistan ce, hyperandrogenism and symptoms of hyperandrogenism (irregular menses, hi rsutism and acne). Hence, the early identification of children at risk for insulin resistance should permit early intervention in order to avoid compl ications.