Introduction

This guideline relates to premature adrenarche in paediatric patients. 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)

Referral criteria/required information

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

How to refer

RCH Specialist Clinics Referral.pdf

Please complete the above and submit via:

• Fax (03) 9345 5034 or
• Email screferrals@rch.org.au
• Urgent referral or clinical query call ED admitting officer, endocrinology fellow or endocrinologist on-call (03) 9345 5522
  

Suggested pre-referral work-up/management 

• Blood sampling:
  • DHEAS
  • Testosterone
  • Androstenedione
  • 17-OHP
  • FSH
  • LH (+ oestradiol if female)
• Bone age X-ray

Acknowledgements

The development of this guideline was coordinated by the Department of Endocrinology. Guideline reviewed in July 2025.