Premature isolated adrenarche in a six-year-old girl

Premature isolated adrenarche is a diagnosis of exclusion that requires careful differential diagnosis and subsequent long-term follow-up to monitor for potential late complications (such as polycystic ovary syndrome, carbohydrate metabolism disorders, and cardiovascular diseases). Conditions that may mimic isolated adrenarche include central precocious puberty and congenital adrenal hyperplasia, both of which necessitate timely diagnosis and appropriate pharmacotherapy. However, in pediatric clinical practice, isolated forms of precocious puberty are more common and require ongoing monitoring to assess the risk of complications involving the carbohydrate metabolism, reproductive, and cardiovascular systems. This article presents a clinical case of isolated adrenarche in a six-year-old girl. Her parents sought medical attention due to the appearance of terminal hair in the axillary region. On physical examination, dark, coarse terminal hair was observed in the axillary, pubic, and perilabial areas, without signs of hirsutism. Laboratory examination revealed increased dehydroepiandrosterone sulfate, whereas markers of congenital adrenal hyperplasia and central precocious puberty were excluded. Based on the patient’s complaints, medical history, and laboratory and instrumental data, a diagnosis of isolated adrenarche was established. The condition was attributed to premature maturation of the adrenal zona reticularis. It was accompanied by increased dehydroepiandrosterone sulfate (as confirmed by laboratory tests), advancement of bone age by one calendar year, and clinical signs such as pubic and axillary hair growth. Comprehensive examination ruled out congenital adrenal hyperplasia, central precocious puberty, adrenal or gonadal tumors. No treatment was indicated in this case. However, regular follow-up is necessary, as scientific data indicate that girls with early adrenarche are at increased risk for developing certain conditions. Parents of children with this variant of precocious puberty should be counseled on the importance of long-term monitoring.