Study of the auxological and psychological characteristics of children with premature adrenarche and the impact of stress in adrenarche onset

Doctoral Dissertation uoadl:2660961 250 Read counter

Τομέας Υγείας - Μητέρας - Παιδιού
Library of the School of Health Sciences
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Marakaki Chrisanthi
Dissertation committee:
Γεώργιος Χρούσος, Καθηγητής, Ιατρική, ΕΚΠΑ
Γεώργιος Μαστοράκος, Καθηγητής, Ιατρική, ΕΚΠΑ
Παπαδημητρίου Αναστάσιος, Καθηγητής, Ιατρική, ΕΚΠΑ
Βασιλική Παπαευαγγέλου, Καθηγήτρια, Ιατρική, ΕΚΠΑ
Χριστίνα Κανακά-Gantenbein, Καθηγήτρια, Ιατρική, ΕΚΠΑ
Κωνσταντίνος Πρίφτης, Αναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ
Παναγιώτα Περβανίδου, Επίκουρη Καθηγήτρια, Ιατρική, ΕΚΠΑ
Original Title:
Μελέτη των αυξολογικών και ψυχολογικών χαρακτηριστικών παιδιών με πρώιμη αδρεναρχή και η επίδραση του στρες στην εμφάνιση της αδρεναρχής
Translated title:
Study of the auxological and psychological characteristics of children with premature adrenarche and the impact of stress in adrenarche onset
Excess of adrenal androgens before puberty is responsible for the appearance of pubic hair before age 8 yr in girls and 9 yr in boys, which is defined as premature adrenarche (PA). Axillary hair, apocrine odor and acne may also be present. The plasma concentrations of adrenal androgens, and mainly DHEAS, are increased for age. Children with PA have an above average body height and weight as well as advanced bone maturation. However, the growth pattern from birth until diagnosis is not well documented. The earlier androgen excess also seems to predispose to metabolic syndrome. Concerns over anxiety and depressive symptoms in children with PA have been recently raised. However, to date, most relevant studies are on a small number of girls.
We aimed to examine any differences in the growth pattern and the age at adiposity rebound (AR) between children with PA and their healthy peers (controls) and whether the growth parameters differed between obese and non-obese PA children, as well as between non-obese PA children and controls. We also aimed to examine the psychological profiles of girls and boys with PA at the time of diagnosis and possible dysregulation of the HPA axis in PA children.

Subjects and Methods
In this cross-sectional study of 82 prepubertal PA children and 63 controls, the main outcome measures were height and body mass index (BMI) Standard Deviation Score (SDS) progression, from birth to presentation at the clinic, baseline biochemical and hormonal evaluation, bone age determination and age at AR. Symptoms of anxiety and depression were assessed by child self-report (Spence Children’s Anxiety Scale and Depression self-rating scale for Children) and parent-report (Child Behaviour Checklist) tests validated for the Greek population. Probable Hypothalamic-Pituitary-Adrenal (HPA) axis dysregulation was assessed by measuring salivary cortisol concentrations which were determined in the morning (7 am) and in the evening (8 pm) of the same day.

PA children were significantly taller and more adipose than controls from the first years of life. 33% of PA children presented the growth pattern of constitutional advancement of growth (CAG), i.e. early growth acceleration, vs. 19% of controls (p=0.045). PA children had an earlier AR compared to controls; mean age at AR in PA girls was 3.73 (1.03) years vs. 4.93 (1.36) years for control girls (p=0.001) and in PA boys was 3.45 (0.73) vs. 5.10 (1.50) years in control boys (p=0.048). Both obese and non-obese PA girls were taller and had earlier age at AR compared to non-obese controls.
Girls with PA scored significantly higher on anxiety (p=0.016) and depression (p=0.039) scales than controls. No group differences were noted for parent reports and children’s salivary cortisol concentrations. Boys with PA did not demonstrate significant differences in any of the aforementioned parameters.

Early AR and CAG may be triggering factors for adrenal androgen production and PA. Our findings suggest that girls with PA may be at higher risk for symptoms of anxiety and depression. HPA axis dysregulation in this population was not documented.
Main subject category:
Health Sciences
Premature adrenarche, Anxiety, Depression, Auxology
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