From the Research
The next step for a girl with adrenarche and elevated DHEA but normal testosterone should be referral to a pediatric endocrinologist for comprehensive evaluation. This specialist will likely order additional tests including a complete adrenal hormone panel, bone age assessment, and possibly an ACTH stimulation test to rule out congenital adrenal hyperplasia or other adrenal disorders 1. While waiting for the specialist appointment, no specific medication is typically needed unless symptoms are severe. The endocrinologist may recommend watchful waiting with regular monitoring if premature adrenarche is diagnosed, as this condition often resolves naturally without intervention. However, if the evaluation suggests an underlying condition like non-classical congenital adrenal hyperplasia, treatment with low-dose glucocorticoids such as hydrocortisone (typically 8-10 mg/m²/day divided into three doses) might be recommended. Elevated DHEA with normal testosterone suggests the issue is primarily adrenal rather than ovarian in origin, which helps guide the diagnostic approach 2. Psychological support should also be considered, as early development of body hair and other adrenarche symptoms can cause emotional distress in young girls.
Some key points to consider in the evaluation and management of this condition include:
- The age of adrenarche and its relation to the development of pubic hair and other secondary sexual characteristics 3
- The distinction between premature adrenarche and precocious puberty, with the former being characterized by increased levels of DHEA and DHEAS without the development of testicular growth or breast development 4
- The potential risks associated with premature adrenarche, including an increased risk of developing the metabolic syndrome and polycystic ovary syndrome (PCOS) 5, 4
- The importance of a thorough history, physical examination, and laboratory evaluation to determine the underlying cause of the elevated DHEA levels and to guide treatment decisions 2, 1