Primary Care Liaison

Premature Adrenarche

  • Introduction

    • Premature adrenarche is different to central precocious puberty
    • Onset of adrenarche (pubic hair, axillary hair, skin changes, body odour) often occurs at a similar time to true puberty but can also be normal in the year or two prior to the onset of either breast development in girls or testicular enlargement in boys.

    When to refer

    • Presence of signs of adrenarche at age <7 years in a girl, <8 years in a boy
    • Adrenarche with tall stature and/or accelerating linear growth rate that is inconsistent with family heights
    • Girl of any age with signs of virilisation (eg clitoral enlargement or virilisation of genitalia, voice change)

    Initial work up

    • DHEAS, testosterone, androstenedione, 17-OHP, FSH, LH (+ oestradiol if female)
    • Bone age X-ray

    Referral information needed

    • Clinical assessment –degree of pubic hair progression, any other virilisation (eg clitoral enlargement in a girl, marked acne or voice change in either sex), blood pressure
    • Height and weight (and date of assessment)
    • ?evidence of true puberty (breast development in a girl, testicular volume ≥4ml in a boy)
    • Copies of pathology and bone age X-ray results

    Contact information

    • For clinical advice, the endocrinology fellow or endocrinologist on call can be contacted through the hospital switch board (03) 9345 5522
    • Outpatient booking enquiry information (03) 9345 6180


    • Guideline developed by RCH Endocrinology Department