Premature Pubarche (PP) refers to the early onset of pubic hair, body odor, and/or axillary hair in girls less than 8 years of age and boys less than 9 years. Premature adrenarche (PA) refers to the early onset of those symptoms in those age groups and is associated with increasing levels of adrenal androgens into the pubertal range. Idiopathic PA is more commonly observed in girls by a ratio of 9:1. Once thought of as a benign condition, new studies are linking PA to functional hyperandrogenism, polycystic ovarian syndrome, hyperinsulinism, Type II diabetes, and metabolic syndrome. PA needs to be distinguished from other conditions requiring treatment, including late-onset congenital adrenal hyperplasia (CAH), virilizing adrenal or gonadal tumors, or exogenous exposure to androgens. A bone age (BA) x-ray is the single most important diagnostic test. Linear growth rate in PA and PP is within 2.5 SDs of normal with no evidence of a linear growth spurt.
