What Is a Premature Pubarche?
Premature pubarche (also referred to as premature adrenarche) is defined as the appearance of pubic hair in females before the age of eight and in boys before the age of nine, without any other indicators of puberty or virilization. The growth rate may be accelerated, and somewhat advanced bone maturation is common and frequently connected with height and age. The beginning and progression of puberty, as well as the final height, are unaffected by the temporary acceleration of growth and bone maturation. Pubarche is the physical expression of adrenarche. It is marked by the appearance of pubic hair, axillary hair, adult apocrine body odor, acne, and a rise in hair and skin oiliness. Females are usually affected more frequently as compared to males.
What Are the Causes of Premature Pubarche?
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Premature adrenarche (PA) is the most common cause of premature pubarche or the development of pubic hair before the age of eight years in girls and nine years in boys. In both boys and girls, adrenarche is the maturation of the adrenal zona reticularis, which results in pubic hair, axillary hair, and adult apocrine body odor.
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Premature adrenarche has been linked to insulin resistance and the eventual development of metabolic syndrome (MeS) and polycystic ovarian syndrome (PCOS).
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It could be a symptom of hormone imbalance-causing disorders, such as Cushing's disease or congenital adrenal hyperplasia (CAH).
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Premature pubarche is more common in children who are born prematurely small for their gestational age. It does not seem to be transmitted.
What Are the Symptoms of Premature Pubarche?
The Center for Disease Control (CDC) defines puberty as transitioning from middle childhood to adolescence (teenage).
The following signs and symptoms can be present in a child with premature pubarche before the age of puberty-
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Hair growth in the pubic area.
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Body odor (armpits).
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Oily hairs.
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The child's rapid and unexplained growth (often above the 90th percentile).
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There is no breast development in girls, and in boys, there is no genital enlargement.
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Although there is a little increase in development velocity and skeletal age (which corresponds to height age), pubertal timing and adult height are mainly unaffected.
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Severe androgen excess (e.g., clitoral enlargement, rapid growth, severe acne) should be investigated further to rule out a rare virilizing tumor or a variant form of congenital adrenal hyperplasia.
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The adrenal hormones that cause early pubic hair are distinct from those that cause breast enlargement (estrogens produced by the ovaries) or penis growth (the testosterone from the testes). Thus, a young girl with only pubic hair and body odor is unlikely to experience early menstrual cycles, which typically do not begin until at least two years after breast enlargement.
How Is Premature Pubarche Diagnosed?
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When clinical signs of premature pubarche are identified, a thorough physical examination and analysis of the child's growth chart should be carried out.
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The diagnosis is made when all other causes of prepubertal hyperandrogenism have been ruled out.
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To evaluate bone age, some doctors will take a hand X-ray. Many children, particularly those who are taller and heavier, have a bone age that has advanced by two or more years, but this does not appear to signal a more significant condition that necessitates further testing or treatment.
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A blood test can be done to check hormone levels.
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Many doctors only test children who have rapid growth or expansion of the genitals or breast development in addition to pubic hair.
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In patients with premature pubarche, rapid progression of pubarche, fast-growth velocity, and advanced bone age should be regarded as alarm signals.
What Is the Treatment for Premature Pubarche?
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As this is a benign condition affecting children, there is usually no special treatment.
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There is no way to get rid of pubic or underarm hairs using any medicine or treatment.
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The adrenal hormones produced in children with premature pubarche are unaffected by medications that halt the course of true precocious puberty.
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Deodorants are both effective and safe for managing body odor.
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The doctor may decide to re-examine the child after six months to check for any symptoms that have progressed and to ensure that the child is growing at a normal rate.
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Children with this condition are at a higher risk for obesity and type 2 diabetes. Thus, diet and exercise counseling is essential.
Other Than Premature Adrenarche, What Else Can Induce Early Pubic Hair in Children?
Premature adrenarche, which is a premature rise in androgen synthesis in the adrenal gland and is regarded as relatively safe, is the most common reason. Premature pubarche can also be caused by severe pathology, so it is crucial to determine what is causing the early exposure to androgens.
Some of the factors responsible for premature pubic hairs are-
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Nonclassical (mild) congenital adrenal hyperplasia (CAH) is a hereditary adrenal disease that affects a small percentage of children.
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Early pubic hair can be an indication of an adrenal or gonadal (testicular or ovarian) tumor. However, in those cases, very rapid growth with enlargement of the clitoris in a girl or the penis in a boy will indicate that the child needs additional testing.
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Pubic hairs may form as a result of taking hormone supplements.
Conclusion
Premature pubarche (premature adrenarche) is defined as the appearance of pubic hair in females before the age of eight to nine years and in boys before the age of nine to ten years, without any other indicators of puberty or virilization. The growth rate may be accelerated, and somewhat advanced bone maturation is common and frequently connected with height and age. The beginning and progression of puberty, as well as the final height, are unaffected by the temporary acceleration of growth and bone maturation. Exclusion of other kinds of hyperandrogenism, such as precocious puberty, late-onset congenital adrenal hyperplasia, virilizing tumors, glucocorticoid resistance, and Cushing syndrome, is used to make the diagnosis. There is no need for treatment once the diagnosis has been made. However, these patients should be followed up for a long time.
