Urinary Estrogens in Girls Throughout Puberty as a Marker of Metabolic Risk and Their Relationship With Premature Adrenarche.

Objective: The relationship between biochemical premature adrenarche (PA) in girls and metabolic alterations during puberty it is well described. A part of these circulating androgens undergoes aromatization in peripheral tissues to estrogens. This raises the question whether the metabolic effects are due to the action of androgens or estrogens. Our aim was to assess whether levels of urinary estrogens are associated with metabolic risk at late stages of puberty in girls with and without PA.

Methods: This prospective observational study included 321 girls from the Growth and Obesity Chilean Cohort Study (GOCS). Anthropometric and biochemical variables included in metabolic syndrome score (MetS) were measured along with urinary estrogens at Tanner stage B4, 1-year (M1) and 4-years after menarche (M4). Relationships between urinary estrogens and metabolic syndrome were analyzed during these periods. Furthermore, we analyzed whether metabolic disturbances in patients with biochemical PA (based on DHEA-S levels at age ~7) were mediated by androgens or estrogens.

Results: In multilevel analysis urinary estrone correlated positively with anthropometric variables (BMI, WC and fat percentage) and MetS score in adolescent girls. In contrast, urinary estradiol was not associated with metabolic risk. Interestingly, urinary estrogens were not associated with metabolic score in patients with biochemical PA.

Discussion: Our investigation suggests that metabolic risk in patients without biochemical PA are mostly associated with estrone levels. In contrast, in patients with biochemical PA, androgens are associated with MetS. Therefore, metabolic disturbances throughout puberty might be generated by different pathways in girls with and without biochemical PA.