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Body mass index at the presentation of premature adrenarche is associated with components of metabolic syndrome at puberty

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Abstract

The aim of this study was to analyze the relationship between premature adrenarche (PA) and metabolic syndrome (MeS) parameters at presentation and during puberty. This study comprised 47 girls with PA. Age- and puberty-matched 22 healthy girls without PA were the control group. Patients were evaluated at admission (first evaluation) and later in puberty (second evaluation). Anthropometric measurements, lipid levels, and hormonal parameters were studied and oral glucose tolerance test was performed. Indices for insulin resistance (IR) were calculated. The study group was divided in subgroups according to body mass index (BMI) and compared with the control group. The age of the PA group at first evaluation was 8.0 ± 1.1 years; mean height SDS and BMI SDS were 0.4 ± 1.2 and 0.6 ± 0.9, respectively. Age of PA group at the second evaluation was 12.9 ± 2.4 years. Frequency of obesity and overweight was 14.9 and 23.4%. Dyslipidemia ratio was 28.3%. PA group had significantly higher BMI than controls. Mean insulin concentration was higher and mean glucose and FGIR were lower in PA group and also dyslipidemia ratio was 5.3 times higher in PA than controls (p = 0.040). In PA group, overweight/obese subjects had still higher BMI at second evaluation and also higher fasting glucose, insulin, HOMA-IR. However, PA children with exaggerated DHEAS concentrations compared to those without had similar BMI SDS, insulin sensitivity, and secretion indices and lipid profile at second evaluation. BMI SDS at first evaluation was positively correlated with HOMA-IR at puberty; however, there is no correlation between DHEAS at first evaluation and HOMA-IR at puberty.

Conclusion: BMI at adrenarche is more important than prepubertal adrogen concentrations such as DHEAS, while predicting the IR in puberty. Long-term follow-up of children supports the observation that PA per se may be related to IR; however, the risk increases with obesity.

What is Known:

• Premature adrenarche (PA) is receiving more attention as evidence emerges for a relation between early androgen excess and metabolic syndrome.

• The onset of the adrenal androgen production before 8 years in girls defined as PA. Pubarche, axillary hair, apocrine body odor, acne are typical phenotypic features of PA.

What is New:

• Body mass index at adrenarche is an important risk factor for development of insulin resistance in pubertal ages.

• Degree of dehydroepiandrosterone sulfate elevation was not shown as a risk factor for insulin resistance.

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Abbreviations

AI:

Atherogenic index

AS:

Androstenedione

BP:

Blood pressure

DHEAS:

Dehydroepiandrosterone sulfate

ECLIA:

Electrochemiluminiscense immunoassay

E2:

Estradiol

FGIR:

Fasting glucose to insulin ratio

FSH:

Follicle-stimulating hormone

FT4:

Free thyroxine

GA:

Gestational age

HDL:

High density lipoprotein

HOMA-IR:

Homeostasis model assessment–insulin resistance

IDF:

International Diabetes Federation

IR:

Insulin resistance

IRMA:

Immunoradiometric assay

ISI:

Insulin sensitivity index

LDL:

Low density lipoprotein

LH:

Luteinizing hormone

MeS:

Metabolic syndrome

OGTT:

Oral glucose tolerance test

PCOS:

Polycystic ovary syndrome

PA:

Premature adrenarche

RIA:

Radioimmunoassay

SGA:

Small for gestational age

SHBG:

Sex hormone binding globulin

TSH:

Thyroid stimulating hormone

TC:

Total cholesterol

T2DM:

Type 2 diabetes

VLDL:

Very low density lipoprotein

WC:

Waist circumference

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Funding

This work was supported by Scientific Research Projects Coordination Unit of Istanbul University (Grant number 42752). Scientific Research Projects Coordination Unit had no role in study design, in the collection, analysis, and interpretation of data, in the writing of the report nor in the decision to submit the paper for publication.

Author information

Author notes

  1. Gamze Kaya and Zehra Yavas Abali contributed equally to this work.

Authors and Affiliations

  1. Istanbul Faculty of Medicine, Department of Pediatrics, Istanbul University, Istanbul, Turkey

    Gamze Kaya

  2. Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Istanbul University, Capa, 34093, Istanbul, Turkey

    Zehra Yavas Abali, Firdevs Bas, Sukran Poyrazoglu & Feyza Darendeliler

Authors
  1. Gamze Kaya
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  2. Zehra Yavas Abali
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  3. Firdevs Bas
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  4. Sukran Poyrazoglu
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  5. Feyza Darendeliler
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Contributions

All authors contributed to the conception and design of the study. GK actively collected data of the study participants. All authors except ZYA were responsible for the collection of data of the study participants and monitored patient inclusion. GK, ZYA, FB, and FD performed statistical analysis, interpretation of data. GK and ZYA drafted the initial manuscript. ZYA, SP, FB, FD reviewed the manuscript and approved the final manuscript as submitted. All authors contributed intellectually to the manuscript and have read the manuscript.

Corresponding author

Correspondence to Feyza Darendeliler.

Ethics declarations

Ethics

Ethical approval was obtained from the Istanbul University Istanbul Faculty of Medicine Clinical Research Ethical Committee (Number 2013-1550, 08.11.2013-19). Informed consent was obtained from all parents and children older than 12 years.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all participants in the study.

Additional information

Communicated by Peter de Winter

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Kaya, G., Yavas Abali, Z., Bas, F. et al. Body mass index at the presentation of premature adrenarche is associated with components of metabolic syndrome at puberty. Eur J Pediatr 177, 1593–1601 (2018). https://doi.org/10.1007/s00431-018-3211-1

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  • DOI: https://doi.org/10.1007/s00431-018-3211-1

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