What are the signs of premature adrenarche in a 6½‑year‑old girl?

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Znaci prevremene adrenarhe kod djevojčice od 6½ godina

Prevremena adrenarha kod djevojčice od 6½ godina manifestuje se pojavom pubične i/ili aksilarne dlake, ubrzanim rastom, akni, masnom kožom ili kosom, i znojenjem odraslog tipa, uz povišene nivoe DHEAS u serumu. 1, 2

Klinički znaci

Najizraženiji znak prevremene adrenarhe je pojava pubične i/ili aksilarne dlake prije 8. godine života kod djevojčica 2, 3. Međutim, ovo nije jedini znak koji treba prepoznati:

Dermatološke manifestacije

  • Akne - mogu biti izražene i zahtijevati lokalnu terapiju 4
  • Masna koža ili kosa 1, 2
  • Komedoni 1
  • Znojenje odraslog tipa (apokrine žlijezde) 1, 4

Promjene u rastu

  • Ubrzani rast u visinu - često prisutan čak i prije pojave pubične dlake 4, 5
  • Napredovanje koštane dobi za približno 1 godinu u odnosu na hronološku dob 4, 5
  • Djeca su često viša od vršnjaka 2, 5

Tjelesna građa

  • Često prisutna prekomjerna tjelesna težina 2, 5
  • Gojazna djeca pokazuju izraženije napredovanje koštane dobi i linearnog rasta 5

Hormonalni profil

Povišeni nivoi DHEAS su najbolji serumski marker adrenalne androgene sekrecije i ključni za dijagnozu 1, 4. Dodatno:

  • Androstenedion i testosteron pozitivno koreliraju sa DHEAS vrijednostima 4
  • Dihidrotestosteron također može biti povišen 4
  • Nivoi hormona odgovaraju ranoj ženskoj puberteti 3

Važne kliničke napomene

Ključna razlika: Prevremena adrenarha se mora razlikovati od prerane pubertete - kod prevremene adrenarhe nema razvoja dojki niti drugih znakova centralne pubertete 6, 3.

Diferencijalna dijagnoza - isključiti:

  • Kongenitalna adrenalna hiperplazija (najčešći patološki uzrok) 7, 3
  • Androgen-producirajuće tumore 2
  • Pranu pubertet 2
  • Egzogeni izvor androgena 1, 2

Prevalencija patologije je izuzetno rijetka - samo 0.52% djece upućene zbog prevremene pubarhe ima adrenalnu patologiju 7. Međutim, kod dječaka je patologija češća (83% slučajeva sa patologijom su bili dječaci) 7.

Dugoročne implikacije

Iako se tradicionalno smatrala benignim stanjem, prevremena adrenarha je povezana sa 8, 6:

  • Hiperinzulinemijom i insulinskom rezistencijom
  • Povećanim rizikom za metabolički sindrom
  • Mogućim razvojem funkcionalnog ovarijalnog hiperandrogenizma (PCOS) u adolescenciji

Uprkos napredovanju koštane dobi, predviđena odrasla visina ostaje normalna i uporediva sa srednjom roditeljskom visinom 5.

Klinički pristup

Kod djevojčice od 6½ godina sa znacima prevremene adrenarhe, potrebno je:

  • Dokumentovati sve kliničke znake androgenog djelovanja
  • Izmjeriti DHEAS, androstenedion i testosteron
  • Procijeniti koštanu dob
  • Isključiti patološke uzroke (posebno CAH testiranjem 17-hidroksiprogesterona)
  • Pratiti rast i tjelesnu težinu
  • Kod gojaznosti fokusirati se na životni stil i kontrolu težine 2

References

1
Research

Premature adrenarche: etiology, clinical findings, and consequences.

The Journal of steroid biochemistry and molecular biology, 2015

3
Research

Normal and Premature Adrenarche.

Endocrine reviews, 2021

6
Research

[Premature pubarche].

Acta bio-medica de L'Ateneo parmense : organo della Societa di medicina e scienze naturali di Parma, 2000

8
Research

Premature adrenarche: novel lessons from early onset androgen excess.

European journal of endocrinology, 2011

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