SUN-186 Advanced Skeletal Maturation in Children: The Role of Obesity and Adrenal Androgen Excess

Abstract Disclosure: Y. Choi: None. E. Hwang: None. J. Kim: None. S. Kim: None. J. Suh: None. E. Lee: None. H. Chae: None. Background: Skeletal maturation in children and adolescents can lead to premature epiphyseal closure, early pubertal onset, and various psychological and social challenges. This study aimed to investigate the relationship between obesity and adrenal androgen levels in skeletal maturation and further explore their association with the development of metabolic disorders. Methods: This cross-sectional study included 1,660 children aged 4-12 years who visited the clinic for pubertal assessment. Data were collected on anthropometric measures, serum biochemical analyses, adrenal androgen levels, sex steroids, and bone age X-rays. Correlation analysis and multivariable linear regression were performed to assess the associations between skeletal maturation (dBACA) and independent variables. Subgroup analyses were conducted based on age and sex, focusing on the pre-adrenarche phase. Results: A total of 1,252 subjects were included in the final analysis (831 normal weight, 421 overweight/obese). dBACA and DHEA-S levels were significantly higher in the overweight/obese group compared to the normal weight group (dBACA: 1.39±0.98 vs. 1.74±0.95, P<0.001; DHEA-S: 50.16±37.62 vs. 62.75±45.95, P<0.001). Correlation analysis revealed positive associations between dBACA and BMI SDS (r=0.21, P<0.001), DHEA-S (r=0.19, P<0.001), and IGF-1 (r=0.27, P=0.029). Notably, in boys under 7 years, stronger correlations were observed for BMI SDS (r=0.46, P<0.001) and DHEA-S (r=0.55, P=0.007). Multivariable linear regression confirmed independent associations of skeletal maturation with BMI SDS (b=0.161, P<0.001) and DHEA-S (b=0.005, P=0.010). These associations were more pronounced in boys under 7 years (BMI SDS: b=0.383, P=0.030; DHEA-S: b=0.025, P=0.009). However, no significant associations were found between skeletal maturation and metabolic markers in this cohort. Conclusion: Obesity and elevated adrenal androgen levels are independently associated with advanced skeletal maturation in children, with stronger associations observed in boys under 7 years before the onset of significant adrenal androgen secretion. These findings suggest that early obesity and adrenal androgen excess may contribute to accelerated skeletal maturation and its associated risks. Presentation: Sunday, July 13, 2025