Bone age advancement in non-obese children with premature adrenarche: relationship to growth acceleration and predicted adult height outcomes.

Abstract

Objectives: Premature adrenarche (PA) is commonly associated with bone age (BA) acceleration, but it is difficult to assess the independent contribution of adrenal androgens to skeletal maturation in studies that include obese children. This study examined BA advancement in non-obese children with PA and evaluated predicted adult height (PAH) estimates in this population.

Methods: The medical records of children diagnosed with PA between April 2022 and April 2023 were reviewed retrospectively. Children who were obese, had congenital adrenal hyperplasia, central precocious puberty, genetic or syndromic disorders affecting growth, or were small for their gestational age were excluded. Anthropometric, hormonal, and radiological data were collected. BA was assessed using the Greulich-Pyle standards, and PAH was calculated using the Bayley-Pinneau method. Analyses were designed to evaluate associations rather than causal relationships.

Results: Eighty-four non-obese children with PA (85.7 % female; mean age 7.41 ± 0.67 years) were included. The mean BA-CA difference was 0.59 ± 0.96 years. Children with a BA-CA difference of ≥1 year had significantly higher height SDS and BA (p<0.001), whereas serum DHEA-S levels did not differ across BA-CA groups. BA-CA was positively associated with height SDS and negatively associated with PAH SDS relative to current height SDS. In multivariable analyses, height SDS showed an independent association with BA advancement, whereas serum DHEA-S did not.

Conclusions: In non-obese children with PA, BA advancement appears to be more closely associated with linear growth status than with circulating DHEA-S concentrations within the constraints of this study design. In most patients, predicted adult height remained within the genetic target range; however, approximately 20 % had PAH values below their mid-parental height. Longitudinal studies incorporating final adult height measurements and comprehensive hormonal profiling are required to clarify long-term growth outcomes.