What Are Adrenal Androgens?
Adrenal androgens are hormones produced by the adrenal cortex, the outer layer of the adrenal glands.
The main adrenal androgens are:
These hormones are much weaker than testosterone but serve as important building blocks that can be converted into stronger sex hormones in other tissues.
What Do Adrenal Androgens Do?
Unlike cortisol and aldosterone, adrenal androgens are not essential for survival.
However, they contribute to several normal developmental changes during childhood.
These include:
These changes are a normal part of growing up.
Adrenarche: A Normal Stage of Development
Around 6–8 years of age, the adrenal glands naturally begin producing larger amounts of adrenal androgens.
This process is called adrenarche.
Adrenarche is a completely normal developmental milestone and occurs before true puberty.
It reflects maturation of the adrenal glands rather than activation of the reproductive system.
Adrenarche Is Not the Same as Puberty
This distinction is one of the most common sources of confusion.
Adrenarche
Adrenarche is driven by the adrenal glands.
Typical features include:
Importantly:
True Puberty
True puberty begins when the brain activates the reproductive hormones through the hypothalamic-pituitary-gonadal (HPG) axis.
This results in:
Girls
Boys
These changes are not caused by adrenal androgens.
Recognising the difference helps doctors determine whether a child is experiencing normal development or requires further evaluation.
What Is Premature Adrenarche?
Some children develop adrenal androgen-related changes earlier than expected.
This is known as premature adrenarche.
It typically refers to:
Other features may include:
Many children with premature adrenarche are otherwise healthy and do not require treatment.
However, evaluation is important to exclude more serious conditions.
Why Does Premature Adrenarche Happen?
In most children, the exact cause is unknown.
The adrenal glands simply begin producing adrenal androgens slightly earlier than usual.
Researchers believe several factors may contribute, including:
In many cases, no specific cause is identified.
When Should Parents Be Concerned?
While premature adrenarche is often benign, some features suggest a condition that requires urgent assessment.
Rapid Progression
Hair growth that progresses rapidly over months rather than years.
Very Early Age
Development of pubic hair in:
deserves prompt evaluation.
Signs of True Puberty
Seek assessment if pubic hair is accompanied by:
Girls
Boys
These may suggest activation of true puberty rather than isolated adrenal androgen production.
Marked Growth Acceleration
Children who suddenly begin growing much faster than expected should be assessed.
Excess androgens can initially increase height velocity but may ultimately reduce adult height by causing the growth plates to mature too early.
Severe Acne or Virilisation
Concerning signs include:
These are not typical of simple premature adrenarche and require specialist evaluation.
Could It Be Something More Serious?
Although uncommon, excessive adrenal androgen production can occur in conditions such as:
This is why a careful medical assessment is important, especially if changes occur very early or progress rapidly.
How Do Doctors Investigate Adrenal Androgen Excess?
Assessment begins with a detailed history and physical examination.
Doctors may ask:
Depending on the findings, investigations may include:
Imaging studies are only required in selected situations.
Does Premature Adrenarche Need Treatment?
For most children with isolated premature adrenarche:
No specific treatment is required.
Instead, doctors monitor:
Regular follow-up helps ensure that the pattern remains consistent with a benign condition.
If an underlying disorder is identified, treatment is directed at the specific cause.
What About Long-Term Health?
Most children with premature adrenarche grow and develop normally.
Some studies suggest that children—particularly girls—with premature adrenarche may have a slightly higher risk of developing:
However, most children do not develop these conditions, and having premature adrenarche alone does not mean they will.
Maintaining a healthy lifestyle, including regular physical activity and balanced nutrition, is beneficial for all children.
When Should Parents Seek Medical Advice?
Arrange an assessment if your child has:
Early evaluation can distinguish normal variation from conditions that require treatment.