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Premature Adrenarche: Advice for Referrers

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Adrenarche is the gradual increase in adrenal androgen secretion after approximately the age of 6 years in girls and 7 years in boys.  It occurs independently from the gonadotrophin-dependent activation of the gonads in central puberty. 

Adrenarche is a normal variant of pubertal development.

Red Flags

Adrenarche results in the development of pubic or axillary hair, body odour or acne. It does not result in breast development or the enlargement of testes

  • Girl <6 years, Boy <7 years
  • Breast development or testicular volume > 4mls (see precocious puberty guideline)
  • Signs of virilisation: cliteromegaly or penile enlargement
Who NOT to refer

Girls over the age of 8 and boys over the age of 9 with signs of adrenarche only.

Use the SPEG flow diagram below.

 

Who to refer
  • Children with signs of Precocious Puberty should be referred directly to Paediatric Endocrinology via SCI gateway
  • Children with RED FLAG features should be referred directly to Paediatric Endocrinology via SCI gateway
  • Children under the age of 8 with no red flag features should be referred to Medical Paediatrics via SCI gateway. See flow chart for more detailed information
  • If there is uncertainty about the diagnosis children should be referred to Medical Paediatrics
Information to include: history
  • Any self-reported findings (e.g. body odour or carer reported cliteromegaly/penile enlargement if not examined)
  • Any previous growth measurement/centiles (to allow determination of increasing height velocity)
  • Parental heights if available
Information to include: examination

Triage of children with possible adrenarche is based on SPEG flow diagram.

Please include:

  • Current height and weight
  • Testicular volume (examined or self-reported) for boys or whether there is any breast development in girls
  • Signs of virilisation: cliteromegaly/penile enlargement. Examined or self-reported
SPEG flow diagram

SPEG premature adrenarche referral flow diagram

Suggestions for management whilst awaiting outpatient appointment

Nil specific.

Resources for parents

SPEG | Adrenarche parent information booklet

Resources for healthcare professionals
  1. SPEG | Adrenarche guideline
  2. RCPCH | Growth charts
References

This guideline has been adapted for local use from the SPEG Adrenarche guideline.

Editorial Information

Last reviewed: 19 March 2024

Next review: 31 March 2027

Author(s): Morag Wilson, Consultant Medical Paediatrics

Version: 1

Reviewer Name(s): Morag Wilson