Premature adrenarche is characterized by which feature?

Premature adrenarche is characterized by which feature?

• A. Central activation of the hypothalamic-pituitary-gonadal axis
• B. Isolated pubic and axillary hair growth with axillary odor due to elevated DHEA
• C. Primary vaginal bleeding
• D. Accelerated linear growth with early epiphyseal fusion

Answer: (B)

Premature adrenarche comes from early maturation of the adrenal glands, leading to increased adrenal androgens such as DHEA and DHEA-S. The hallmark is isolated development of pubic and axillary hair (and sometimes body odor) due to these androgens, without activation of the hypothalamic-pituitary-gonadal axis. Because the gonadal axis isn’t engaged, you don’t see breast development or vaginal bleeding, and growth changes aren’t driven by gonadal steroids in the same way as central puberty. This is why the feature described—pubic and axillary hair growth with axillary odor due to elevated DHEA—is the best answer. In contrast, central activation of the HPG axis would produce signs of gonadarche such as breast development and possibly early menarche; primary vaginal bleeding is not a feature of adrenarche; and accelerated linear growth with early epiphyseal fusion points to estrogen-driven epiphyseal maturation seen in central precocious puberty, not adrenarche.

Premature adrenarche comes from early maturation of the adrenal glands, leading to increased adrenal androgens such as DHEA and DHEA-S. The hallmark is isolated development of pubic and axillary hair (and sometimes body odor) due to these androgens, without activation of the hypothalamic-pituitary-gonadal axis. Because the gonadal axis isn’t engaged, you don’t see breast development or vaginal bleeding, and growth changes aren’t driven by gonadal steroids in the same way as central puberty.

This is why the feature described—pubic and axillary hair growth with axillary odor due to elevated DHEA—is the best answer. In contrast, central activation of the HPG axis would produce signs of gonadarche such as breast development and possibly early menarche; primary vaginal bleeding is not a feature of adrenarche; and accelerated linear growth with early epiphyseal fusion points to estrogen-driven epiphyseal maturation seen in central precocious puberty, not adrenarche.