TOPLINE:

Premature adrenarche, characterised by prepubertal adrenal androgen excess and hyperandrogenic symptoms, was linked to an increased risk for metabolic dysfunction, with affected children exhibiting significantly higher height, weight, BMI, and levels of fasting insulin at presentation than age-matched healthy peers.

METHODOLOGY:

• Researchers in England conducted a systematic review and meta-analysis of case-control studies published from January 1990 to March 2025 to assess the risk for metabolic dysfunction among children presenting with premature adrenarche compared with that among healthy peers.
• Overall, 25 studies involving 694 children with premature adrenarche (88.8% girls) and 567 age-matched healthy control children (85% girls) were included, with participant ages ranging from 3.9 to 10.5 years.
• Premature adrenarche was defined as the presence of clinical signs, such as pubic/axillary hair, body odour, acne, or growth acceleration, before the age of 8 years in girls or 9 years in boys, with or without biochemical evidence of androgen excess.
• Included studies assessed anthropometric measures and markers of glucose and lipid metabolism, such as levels of fasting insulin and low-density lipoprotein.

TAKEAWAY:

• A pooled analysis of 10 studies showed that children with premature adrenarche had significantly higher height SD scores than control children (pooled mean difference [MD], 0.66; 95% CI, 0.36-0.95; I² = 79%), and a meta-analysis of seven studies also found higher weight SD scores among affected children (MD, 0.63; 95% CI, 0.33-0.93; I² = 53%).
• A meta-analysis of eight studies reported higher BMI SD scores among children with premature adrenarche than among control children (MD, 0.36; 95% CI, 0.03-0.69; I² = 73%).
• In a meta-analysis of 12 studies each, children with premature adrenarche exhibited higher levels of fasting insulin (MD, 15.04; 95% CI, 5.27-24.81; I² = 91%) and low-density lipoprotein (MD, 0.15; 95% CI, 0.01-0.30; I² = 55%) than control children.
• Other metabolic risk markers — fasting glucose levels, homeostatic model assessment of insulin resistance, mean serum glucose and insulin levels during the oral glucose tolerance test, and fasting triglyceride and total cholesterol levels — did not differ significantly between both groups.

IN PRACTICE:

"Our present review suggests that children with PA [premature adrenarche] at presentation show early signs of metabolic dysfunction, in addition to tall stature and heavier body weight for height. We observed significant heterogeneity. The use of different PA definitions, ethnic variation, and the contributing impact of obesity, in addition to androgen excess, likely causes this bias," the authors wrote.

SOURCE:

This study was led by Wogud Ben Said, Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, England. It was published online on August 30, 2025, in the European Journal of Endocrinology.

LIMITATIONS:

This study was limited by highly heterogeneous summary measures and a small number of participants in the included studies.

DISCLOSURES:

This study was supported by grant funding from the National Institute for Health and Care Research, UK, and Birmingham Women's and Children's Hospital Charity. One author reported receiving research support from the Wellcome Trust and the Medical Research Council. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.