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Premature adrenarche — RACP Paediatrics MCQ

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ModerateEndocrinePremature adrenarcheRACP Paediatrics

A 6-year-old girl has pubic hair (Tanner stage 2) and mild body odour but no breast development. Growth velocity is slightly increased. Bone age is advanced by 1 year. DHEAS is elevated. LH and FSH are prepubertal. What is the most likely diagnosis?

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Correct answer: C — Premature adrenarche

Isolated appearance of pubic/axillary hair and body odour before age 8 in girls (age 9 in boys) without other pubertal signs, with elevated DHEAS and prepubertal gonadotrophins, is premature adrenarche. Bone age may be mildly advanced. Non-classic CAH (elevated 17-OHP) should be excluded. Most cases are benign but there is an association with PCOS and metabolic syndrome later in life.

Reference: RCH Melbourne – 2023 – Pubertal Variants CPG; RACP Paediatric Curriculum – Endocrine