Adrenarche is an early stage in sexual maturation that happens in some higher

primate Primates is an order (biology), order of mammals, which is further divided into the Strepsirrhini, strepsirrhines, which include lemurs, galagos, and Lorisidae, lorisids; and the Haplorhini, haplorhines, which include Tarsiiformes, tarsiers a ...

s (including

human Humans (''Homo sapiens'') or modern humans are the most common and widespread species of primate, and the last surviving species of the genus ''Homo''. They are Hominidae, great apes characterized by their Prehistory of nakedness and clothing ...

s), typically peaks at around 20 years of age, and is involved in the development of

pubic hair Pubic hair (or pubes , ) is terminal hair, terminal body hair that is found in the sex organ, genital area and pubic region of adolescent and adult humans. The hair is located on and around the sex organs, and sometimes at the top of the inside ...

body odor Body odor or body odour (BO) is present in all animals and its intensity can be influenced by many factors (behavioral patterns, survival strategies). Body odor has a strong genetic basis, but can also be strongly influenced by various factors, ...

, skin oiliness,

axilla The axilla (: axillae or axillas; also known as the armpit, underarm or oxter) is the area on the human body directly under the shoulder joint. It includes the axillary space, an anatomical space within the shoulder girdle between the arm a ...

hair Hair is a protein filament that grows from follicles found in the dermis. Hair is one of the defining characteristics of mammals. The human body, apart from areas of glabrous skin, is covered in follicles which produce thick terminal and ...

sexual attraction Sexual attraction is attraction on the basis of sexual desire or the quality of arousing such interest. Sexual attractiveness or sex appeal is an individual's ability to attract other people sexually, and is a factor in sexual selection or m ...

sexual desire Sexual desire is an emotion and motivational state characterized by an interest in sexual objects or activities, or by a drive to seek out sexual objects or to engage in sexual activities. It is an aspect of sexuality, which varies significantly ...

/increased

libido In psychology, libido (; ) is psychic drive or energy, usually conceived of as sexual in nature, but sometimes conceived of as including other forms of desire. The term ''libido'' was originally developed by Sigmund Freud, the pioneering origin ...

and mild

acne Acne ( ), also known as ''acne vulgaris'', is a long-term Cutaneous condition, skin condition that occurs when Keratinocyte, dead skin cells and Sebum, oil from the skin clog hair follicles. Typical features of the condition include comedo, ...

. During adrenarche the

adrenal gland The adrenal glands (also known as suprarenal glands) are endocrine glands that produce a variety of hormones including adrenaline and the steroids aldosterone and cortisol. They are found above the kidneys. Each gland has an outer adrenal corte ...

s secrete increased levels of weak adrenal androgens, including

dehydroepiandrosterone Dehydroepiandrosterone (DHEA), also known as androstenolone, is an endogenous steroid hormone precursor. It is one of the most abundant circulating steroids in humans. DHEA is produced in the adrenal glands, the gonads, and the brain. It funct ...

(DHEA),

dehydroepiandrosterone sulfate Dehydroepiandrosterone sulfate, abbreviated as DHEA sulfate or DHEA-S, also known as androstenolone sulfate, is an endogenous androstane steroid that is produced by the adrenal cortex. It is the 3β-sulfate ester and a metabolite of dehydroepia ...

(DHEA-S), and

androstenedione Androstenedione, or 4-androstenedione (abbreviated as A4 or Δ4-dione), also known as androst-4-ene-3,17-dione, is an endogenous weak androgen steroid hormone and intermediate in the biosynthesis of estrone and of testosterone from dehydroe ...

(A4), but without increased

cortisol Cortisol is a steroid hormone in the glucocorticoid class of hormones and a stress hormone. When used as medication, it is known as hydrocortisone. Cortisol is produced in many animals, mainly by the ''zona fasciculata'' of the adrenal corte ...

levels. Adrenarche is the result of the development of a new zone of the

adrenal cortex The adrenal cortex is the outer region and also the largest part of the adrenal gland. It is divided into three separate zones: zona glomerulosa, zona fasciculata and zona reticularis. Each zone is responsible for producing specific hormones. I ...

, the

zona reticularis The zona reticularis (sometimes, reticulate zone) is the innermost layer of the adrenal cortex, lying deep to the zona fasciculata and superficial to the adrenal medulla. The cells are arranged cords that project in different directions giving a n ...

. Adrenarche is a process related to

puberty Puberty is the process of physical changes through which a child's body matures into an adult body capable of sexual reproduction. It is initiated by hormonal signals from the brain to the gonads: the ovaries in a female, the testicles i ...

, but distinct from

hypothalamic–pituitary–gonadal axis The hypothalamic–pituitary–gonadal axis (HPG axis, also known as the hypothalamic–pituitary–ovarian/testicular axis) refers to the hypothalamus, pituitary gland, and gonadal glands as if these individual endocrine glands were a single en ...

(HPG axis) maturation and function.

Occurrence

Dehydroepiandrosterone sulfate levels throughout life in human males and females

Adrenarche occurs starting at the age of 6 years. After the first year of life, the adrenal glands secrete very low levels of adrenal androgens. Adrenarche begins on average between age 5 to 8 in girls and between 7 and 11 in boys, and precedes

by about 2 years. Unlike the physical changes that occur during puberty, adrenarche is primarily an emotional and psychological stage of development. It continues throughout puberty, with adrenal androgen levels progressively increasing until reaching maximal levels in young adulthood, around the age of 20 years. Circulating DHEA-S levels specifically peak in humans at about age 19 or 20 years in females and around age 20 to 24 years in males. Levels of

corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invo ...

s like

do not change with adrenarche. Biological messengers during the onset of adrenarche are thought to signal in preparation for puberty.

Role in puberty

An initiator of adrenarche has not yet been identified. Researchers have unsuccessfully tried to identify a new pituitary peptide, to be called "adrenal androgen stimulating hormone". Others have proposed that adrenarchal maturation is a gradual process intrinsic to the adrenal glands that has no distinct trigger. A third avenue of research is pursuing a possible relationship with either fetal or childhood body mass and related signals such as

insulin Insulin (, from Latin ''insula'', 'island') is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the insulin (''INS)'' gene. It is the main Anabolism, anabolic hormone of the body. It regulates the metabol ...

and

leptin Leptin (from Ancient Greek, Greek λεπτός ''leptos'', "thin" or "light" or "small"), also known as obese protein, is a protein hormone predominantly made by adipocytes (cells of adipose tissue). Its primary role is likely to regulate long ...

. Many children born

small for gestational age Small for gestational age (SGA) newborns are those who are smaller in size than normal for the gestational age. SGA is most commonly defined as a weight below the 10th percentile for the gestational age. SGA predicts susceptibility to hypoglycemi ...

(SGA) because of

intrauterine growth restriction Intrauterine growth restriction (IUGR), or fetal growth restriction, is the poor growth of a fetus while in the womb during pregnancy. IUGR is defined by clinical features of malnutrition and evidence of reduced growth regardless of an infant's ...

(IUGR) have an earlier onset of adrenarche, which raises the possibility that timing of adrenarche may be affected by physiological programming in infancy. Adrenarche also occurs prematurely in many children who are

overweight Being overweight is having more body fat than is optimally healthy. Being overweight is especially common where food supplies are plentiful and lifestyles are sedentary. , excess weight reached epidemic proportions globally, with more than ...

, suggesting a possible relationship with body mass or adiposity signals. The principal physical consequences of adrenarche are

androgen An androgen (from Greek ''andr-'', the stem of the word meaning ) is any natural or synthetic steroid hormone that regulates the development and maintenance of male characteristics in vertebrates by binding to androgen receptors. This includes ...

effects, especially

(in which

Tanner stage The Tanner scale (also known as the Tanner stages or sexual maturity rating (SMR)) is a scale of physical development as pre-pubescent children transition into adolescence, and then adulthood. The scale defines physical measurements of developme ...

2 becomes Tanner stage 3) and the change of

sweat Perspiration, also known as sweat, is the fluid secreted by sweat glands in the skin of mammals. Two types of sweat glands can be found in humans: eccrine glands and Apocrine sweat gland, apocrine glands. The eccrine sweat glands are distribu ...

composition that produces adult

. Increased oiliness of the skin and hair and mild

may occur. Pubic hair caused by adrenarche is usually transient and will disappear right before the onset of puberty. In most boys, these changes are indistinguishable from early testicular

testosterone Testosterone is the primary male sex hormone and androgen in Male, males. In humans, testosterone plays a key role in the development of Male reproductive system, male reproductive tissues such as testicles and prostate, as well as promoting se ...

effects occurring at the beginning of gonadal puberty. In girls, the adrenal androgens of adrenarche produce most of the early androgenic changes of puberty: pubic hair, body odor, skin oiliness, and acne. In most girls the early androgen effects coincide with, or are a few months following, the earliest

estrogen Estrogen (also spelled oestrogen in British English; see spelling differences) is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three ...

ic effects of gonadal puberty (breast development and growth acceleration). As female puberty progresses, the

ovaries The ovary () is a gonad in the female reproductive system that produces ova; when released, an ovum travels through the fallopian tube/oviduct into the uterus. There is an ovary on the left and the right side of the body. The ovaries are endocr ...

and peripheral tissues become more important sources of androgens. Parents and many physicians often infer (incorrectly) the onset of puberty from the first appearance of

(termed

pubarche Pubarche () refers to the first appearance of pubic hair at puberty. It is one of the earliest physical changes of puberty and can occur independently of complete puberty. It is usually the second sign of puberty, after thelarche in females and gon ...

). However, the independence of adrenarche and gonadal puberty is apparent in children with atypical or abnormal development, when one process may occur without the other. For instance, adrenarche does not occur in many girls with

Addison's disease Addison's disease, also known as primary adrenal insufficiency, is a rare long-term endocrine disorder characterized by inadequate production of the steroid hormones cortisol and aldosterone by the two outer layers of the cells of the adr ...

, who will continue to have minimal pubic hair as puberty progresses. Conversely, girls with

Turner syndrome Turner syndrome (TS), commonly known as 45,X, or 45,X0,Also written as 45,XO. is a chromosomal disorder in which cells of females have only one X chromosome instead of two, or are partially missing an X chromosome (sex chromosome monosomy) lea ...

will have normal adrenarche and normal pubic hair development, but true gonadal puberty never occurs because their ovaries are abnormal.

Premature adrenarche

Premature adrenarche is the most common cause of the early appearance of pubic hair ("premature

") in childhood. In a large proportion of children it seems to be a variation of normal development requiring no treatment. However, there are three clinical issues related to premature adrenarche. First, when pubic hair appears at an unusually early age in a child, premature adrenarche should be distinguished from true central

precocious puberty In medicine, precocious puberty is puberty occurring at an unusually early age. In most cases, the process is normal in every aspect except the unusually early age and simply represents a variation of normal development. There is early developm ...

, from

congenital adrenal hyperplasia Congenital adrenal hyperplasia (CAH) is a group of Genetic disorder#Autosomal recessive, autosomal recessive disorders characterized by impaired cortisol synthesis. It results from the deficiency of one of the five enzymes required for the Biosy ...

, and from androgen-producing tumors of the adrenals or gonads. Pediatric endocrinologists do this by demonstrating pubertal levels of DHEA-S and other adrenal androgens, with prepubertal levels of

gonadotropin Gonadotropins are glycoprotein hormones secreted by gonadotropic cells of the anterior pituitary of vertebrates. They are central to the complex endocrine system that regulates normal growth, sexual development, and reproductive function. T ...

s and gonadal

sex steroid Sex hormones, also known as sex steroids, gonadocorticoids and gonadal steroids, are steroid hormones that interact with vertebrate steroid hormone receptors. The sex hormones include the androgens, estrogens, and progestogens. Their effects a ...

s. Second, there is some evidence that premature adrenarche may indicate that there was an abnormality of the intrauterine energy environment and of intrauterine growth. As mentioned above, premature adrenarche occurs more often in children with intrauterine growth retardation and in overweight children. Some of these same studies have demonstrated that some girls who display premature adrenarche may continue to have excessive androgen levels in adolescence. This can result in

hirsutism Hirsutism is excessive body hair on parts of the body where hair is normally absent or minimal. The word is from early 17th century: from Latin ''hirsutus'' meaning "hairy". It usually refers to a male pattern of hair growth in a female that ma ...

or menstrual irregularities due to

anovulation Anovulation is when the ovaries do not release an oocyte during a menstrual cycle. Therefore, ovulation does not take place. However, a woman who does not ovulate at each menstrual cycle is not necessarily going through menopause. Chronic anovulat ...

, referred to as

polycystic ovary syndrome Polycystic ovary syndrome, or polycystic ovarian syndrome, (PCOS) is the most common endocrine disorder in women of reproductive age. The name is a misnomer, as not all women with this condition develop cysts on their ovaries. The name origin ...

. Third, at least one report from 2008 found an increased incidence of behavior and school problems in a group of children with premature adrenarche compared with an otherwise similar control group. To date, such a relationship has neither been confirmed nor explained and there are no obvious management implications.

Other primates

Adrenarche occurs in only a small number of primates, and only

chimpanzee The chimpanzee (; ''Pan troglodytes''), also simply known as the chimp, is a species of Hominidae, great ape native to the forests and savannahs of tropical Africa. It has four confirmed subspecies and a fifth proposed one. When its close rel ...

s and

gorilla Gorillas are primarily herbivorous, terrestrial great apes that inhabit the tropical forests of equatorial Africa. The genus ''Gorilla'' is divided into two species: the eastern gorilla and the western gorilla, and either four or five su ...

s show a pattern of adrenarche development similar to humans.

References

External links