Early pubic hair and adrenarche

Management of children presenting with signs of early onset pubic hair/ body odour/acne

Includes guidance for the distinction between adrenarche, precocious puberty and other abnormalities of secondary sexual development

Purpose of this document

  • To guide evaluation of a child presenting with pubic hair, body odour and acne prior to the onset of puberty

  • To clarify the distinction between adrenarche, precocious puberty and other abnormalities of secondary sexual development.

Who should use this document

General practitioners, paediatricians, and paediatric endocrinologists.

Patients to whom this document applies

Children presenting with pubic hair growth, axillary hair, body odour and acne before the expected age of puberty – this usually (but not always) reflects adrenarche.

Definition of adrenarche

Adrenarche is the normal, physiological 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.

Clinical features

Adrenarche results in the development of pubic hair, axillary hair, body odour and acne. (It does not result in the enlargement of the breasts, penis, or testes).

Biochemical findings

The diagnosis can be made on clinical features without further investigations, see clinical guide. During adrenarche the maturation of the adrenal glands is associated with increased production of dehydroepiandrosterone sulphate (DHEAS) relative to cortisol. The serum concentration of DHEAS can be used as a marker for the presence of adrenarche, with serum testosterone and androstenedione levels typically lying around the upper limit of the reference range.

Clinical significance

Adrenarche is a normal component of pubertal development – it occurs in everyone but the manifestations vary. It is important to distinguish this from precocious puberty and virilising conditions such as androgen secreting tumours and Congenital Adrenal hyperplasia. Adrenarche itself does not require treatment.

Refer patients for further assessment according to flowchart or if there are concerns regarding rapid progression of symptoms. 

Adrenarche clinical guide

Accessibility tools