Adrenarche is the gradual increase in adrenal androgen secretion after approximately the age of 6 years in girls and 7 years in boys. It occurs independently from the gonadotrophin-dependent activation of the gonads in central puberty.
This guidance applies to children with signs of adrenal hormone secretion, i.e pubic hair growth, body odour, greasy skin, but NO breast development in girls or testicular enlargement in boys. The latter are suggestive of gonadotrophin driven pubertal development and depending on the age of the child, may justify further investigations.
Clinical Significance
Adrenarche is a normal variant of pubertal development and does not require treatment. There has been previous concern that adrenarche may be associated with the development of insulin resistance, polycystic ovarian syndrome and metabolic syndrome, but this does not alter management or follow up.
Initial assessment should include:
- history of growth acceleration with plotting of height on growth chart, ideally plotting of both parents’ height
- clinical examination for signs of pubertal development (breast buds in girls, testicular volumes in boys).
- Examination for signs of androgen exposure, such as axillary or pubic hair, greasy skin and body odour.
- Examination for signs of virilisation, specifically cliteromegaly or penile enlargement.
Who to refer:
The following pathway gives more detailed guidance on differentiating children with simple adrenarche from those with pathological androgen excess or precocious puberty:
Adrenarche guideline – right decision service
In short, the following children should be referred:
- Girls under the age of 6 years, and boys under the age of 7 years, even if there are no other concerning features.
- Girls with cliteromegaly, and boys with penile enlargement.
- Children with signs of true central precocious puberty (breast development under the age of 8 years, or testicular enlargement under the age of 9 years).
Who not to refer:
Girls > age 6 and boys > age 7 with signs of adrenarche only. These children do warrant a follow-up appointment in primary care to ensure there is no growth acceleration or evolving signs of true precocious puberty or virilisation.
How to refer:
Please refer via SCI Gateway to RHCYP – Endocrinology
The Scottish paediatric endocrine group website contains useful SPEG parent information leaflets, including for adrenarche.
Adrenarche guideline – right decision service
RCPCH Growth Charts
