Pediatric Premature Adrenarche (PA)

Pediatric premature adrenarche (PA) is the early appearance of pubic hair before puberty.

What is Pediatric Premature Adrenarche (PA)?

Puberty typically occurs between the ages of 10 and 14 for girls. If a child has premature adrenarche, changes occurs prior to age 8. It is more common in African-American and Hispanic girls as well as girls with obesity and insulin resistance.

What are the signs and symptoms of Pediatric Premature Adrenarche (PA)?

  • Body odor, especially in the armpits
  • Oily skin
  • Pubic hair growth
  • Unexplained and rapid growth (often above the 90th%)

*Age of puberty is middle childhood to teenage years as defined by the Center for Disease Control (CDC).

How is Pediatric Premature Adrenarche (PA) diagnosed?

Your daughter’s doctor will first ask questions about when the hair growth started and where else hair growth is noted (such as in the arm pits). The doctor will then perform a physical exam, which may include checking for any breast growth and other signs of possible early puberty.  Your doctor will order blood hormone levels and check and x-ray of the hand and wrist (a Bone Age) to determine if this is a normal variant or if treatment for precocious puberty is warranted.

What are the causes of Pediatric Premature Adrenarche (PA)?

The exact cause of premature adrenarche is often unknown. In the absence of any other signs of puberty, it can be considered an extreme variant of normal development. It is also often associated with obesity and insulin resistance. It can be a symptom of a condition that causes a hormonal imbalance, such as:

How is Pediatric Premature Adrenarche (PA) treated?

If your daughter is diagnosed with premature adrenarche, there is usually no specific treatment as this is a benign condition in children. Your doctor may reassure you that your daughter’s condition is a variation of normal, and that puberty may follow normally as you child gets older. Your doctor may also choose to re-examine your daughter in 6 months to monitor for any progression of her symptoms and make sure that she is growing at a normal rate. Counseling about a diet and exercise will also be done as girls with this condition may be at a higher risk for obesity and type 2 diabetes.

Pediatric Premature Adrenarche (PA) Doctors and Providers