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Premature adrenarche is the most common cause of the early appearance of pubic hair ("premature pubarche") in childhood. In a large proportion of children it seems to be a variation of normal development requiring no treatment. However, there are three clinical issues related to premature adrenarche.
Congenital adrenal hyperplasia due to 3β-hydroxysteroid dehydrogenase deficiency is an uncommon form of congenital adrenal hyperplasia (CAH) resulting from a mutation in the gene for one of the key enzymes in cortisol synthesis by the adrenal gland, 3β-hydroxysteroid dehydrogenase (3β-HSD) type II ().
Late onset congenital adrenal hyperplasia (LOCAH), also known as nonclassic congenital adrenal hyperplasia (NCCAH or NCAH), is a milder form of congenital adrenal hyperplasia (CAH), [1] a group of autosomal recessive disorders characterized by impaired cortisol synthesis that leads to variable degrees of postnatal androgen excess.
Puberty usually begins around ages 10—11 in females and around ages 11—12 in males. [7] Body weight and nutrition status is evidenced to have an effect on puberty onset as well, due to some input from adipose tissue hormonal signaling. [8] Puberty involves both the processes of gonadarche and adrenarche. [6]
However, premature pubarche may also arise independently of adrenarche. Premature pubarche is a subset of precocious puberty which divide into 1) true precocious puberty that includes complete and central precocious puberty and 2) incomplete puberty which has 3 subsets: premature thelacrche, premature pubarche and isolated menarche. [13]
Premature thelarche is a benign condition in which a young female has breast development before age eight without any accompanied pubertal changes. [2] [7] [15] [16] Individuals undergoing isolated premature thelarche do not experience menstruation, pubic hair growth , or the bone growth characteristic of puberty. [15]
The Moro reflex may be observed in incomplete form in premature birth after the 25th week of gestation, and is usually present in complete form by week 30 (third trimester). [1] Absence or asymmetry of either abduction or adduction by 2 to 3 months age can be regarded as abnormal, as can persistence of the reflex in infants older than 6 months. [3]
Persistent adrenarche syndrome is a cutaneous condition seen typically in thin young women who report great psychological and physical stress in their lives. [1]