2025 – PAGE 63 – ADOLESCENT MEDICINE
(DOUBLE TAKE) NORMAL ADRENAL STEROID SYNTHESIS PATHWAY
TROPIC
In endocrinology, TROPIC refers to central hormones. Break down big words. So HYPERGONADOTROPIC refers to an excess of central hormones
PREMATURE THELARCHE
Premature thelarche is defined as thelarche prior to the age of 8, though most cases occur around 2 years of age. Breast development can be unilateral or bilateral, and it’s not associated with other secondary sex characteristics. There’s normal linear and bone growth. This is usually benign. Treat with reassurance and frequent office visits to ensure there are no additional signs of early puberty.
PEARL: You might hear a parent say, “My baby had boobies since the day she was born!” This is NOT a big deal unless she’s also having menses. Again, this condition is usually benign.
PEARL: If there are additional pubertal signs, look for evidence of excess estrogens from an exogenous source, an estrogen-secreting tumor, or early activation of the hypothalamic-pituitary axis. Endocrinology referral is also warranted.
PREMATURE ADRENARCHE IN GIRLS
Premature adrenarche is defined as having hair development prior to the age of 8 without breast development or other signs of puberty. Get bone age films! The bone age should be within one year of the chronological age. If that’s the case, then it’s okay just to observe at this age!
PEARL: In patients less than 8 years of age with hair development without breast development, look out for extra androgens in the form of exogenous androgens (oral? topical?), ANDROGEN-SECRETING TUMOR, CAH, or EARLY ADRENAL PUBERTY. ADRENAL glands are typically responsible for the ANDROGENS that result in ADRENArche. Remember that LH and FSH are gonadoTROPES and are from the pituitary, not released from the adrenals or gonads. However, elevation in LH and FSH can result in GONADAL androgen production. Ovaries ALSO PRODUCE TESTOSTERONE. If that’s difficult to remember, “think of it this way: In CAH, excess progesterone results in excess androgens being formed. So, maybe the same holds true for excess progesterone floating around from ovarian production!”