Have you started to notice some changes in your little one's body, perhaps even earlier than you thought? Does it sometimes feel like a little hair is growing in the armpits or private parts, or does it feel like a sweaty smell? It's normal for a mother or father to feel a little scared and worried when they see these things. So today, let's talk about a natural process called adrenarche, which may be the cause of this.
Do you know what Adrenarche is?
Simply put, Adrenarche is a natural process in which your child's adrenal glands start producing more of a hormone called DHEA (Dehydroepiandrosterone). This usually starts between the ages of 6 and 8. To be precise, this happens about two years before the child begins to show signs of puberty (pubarche).
Think of this hormone DHEA as a raw material. Our body uses it to make other important hormones. For example, hormones in the androgen group (such as testosterone and androstenedione) and the hormone estrogen are also made from this DHEA. These androgen hormones help initiate puberty, and are also important for reproductive health and body growth.
Another form of DHEA is called DHEAS (Dehydroepiandrosterone-sulfate). This is the form of DHEA that circulates in our blood. A blood test can measure the level of DHEAS to determine whether adrenal function is occurring. However, because this is a natural process, this blood test is not routinely done on children.
What actually happens during adrenarche?
During adrenarche, the outer part of your baby's adrenal glands, the adrenal cortex, begins to develop and mature.
There are three layers of this adrenal cortex:
- Zona glomerulosa (outermost layer)
- Zona fasciculata (middle layer)
- Zona reticularis (innermost layer). This part, called the zona reticularis, is the most developed in adrenal cancer.
As this develops, the adrenal glands produce DHEA, which the body then converts into androgen hormones. This DHEA and the hormones it produces are what initiate or increase the following:
- Sebaceous glands: These are glands in our skin that produce an oily secretion (sebum). This secretion helps the skin retain moisture and provides a protective coating. Their function also affects body odor.
- Apocrine glands: These are specialized glands found in areas such as the armpits and groin. They remain inactive until stimulated by adrenal hormones during the adrenal cycle.
- Pubic and axillary hair: Pubic hair is a type of hair that is slightly darker and thicker. It is due to the androgen hormone that pubic and axillary hair begins to grow.
Importantly, these adrenal hormones are different from the hormones that cause breast enlargement and male genitalia (called gonadarche) during puberty. Gonadarche is the increased production of the main sex hormones (estrogen or testosterone) by the ovaries and testicles. These organs and hormones are needed for sexual reproduction. Adrenal hormones are not directly involved.
Adrenarche and gonadarche are two separate, independent processes. Researchers still don't know exactly what triggers adrenarche.
How long does Adrenarche last?
Adrenarche usually lasts about two years, until the onset of pubarche, the first sign of puberty. However, your child's adrenal glands continue to produce DHEA well into adulthood. DHEA levels are highest in young adulthood (around 20-24 years of age), and then gradually decline as you get older.
What are the symptoms of Adrenarche?
In fact, there are no obvious physical signs of adrenarche. That is, when DHEA levels first increase, there is no visible change in the child's body directly related to it.
However, about two years after the onset of adrenal insufficiency, pubarche , or pubic hair, begins to appear. Doctors consider this to be the physical result of adrenal insufficiency. Pubarche marks the beginning of puberty.
Other features of pubic hair are:
- The appearance of axillary hair.
- Sweat odor (body odor / apocrine odor).
- Increased oiliness of the child's skin and hair.
- Acne.
At what age does pubic hair usually start to appear?
This actually varies slightly from child to child, depending on whether they are male or female, and also by race and ethnicity. For example, here are the average age ranges according to surveys conducted in the United States:
- For non-Hispanic black girls, around 9.5 years old.
- For Mexican-American girls, it's around 10.3 years old.
- For non-Hispanic white girls, around 10.5 years old.
- For non-Hispanic black boys, it's around 11.1 years old.
- For Mexican-American boys, around 12.3 years old.
- For non-Hispanic white boys, around 12 years old.
The important thing is that not all children are the same, and everyone's body develops in their own way. These age ranges may be approximately the same for children in Sri Lanka, but there are differences from child to child. If you have any questions or doubts about your child's development, the best thing to do is to talk to your pediatrician.
What is Premature Adrenarche?
Premature adrenarche is when things like pubic and armpit hair and bad breath start earlier than expected. Typically, these symptoms appear before the age of 8 in girls and before the age of 9 in boys. This may be premature adrenarche.
This is actually called premature pubarche, because we have no way of knowing whether the internal process called adrenarche has started early, until the physical sign of it, pubarche, appears.
Research shows that girls are about nine times more likely to develop this condition than boys. The exact reason for this is not yet known.
What are the symptoms of premature adrenarche?
The main symptoms of adrenal insufficiency are:
- Hair appearing in the pubic area and/or armpits before the age of 8 for a girl, or before the age of 9 for a boy.
- Body odor from armpits can cause a need to use something like deodorant.
Children with this type of adrenal insufficiency are often taller than others their age, sometimes even above the 90th percentile on height charts for their age and gender.
But here's something to keep in mind: Precocious puberty does not cause premature breast development or early sexual development in boys (i.e., gonadarche). If your child is showing these breast or sexual changes early, along with the hair growth and body odor, it's probably not precocious puberty, but rather a condition called precocious puberty . That's a different matter.
How is Premature Adrenarche Diagnosed?
If your child is suspected of having symptoms of adrenal insufficiency, your pediatrician will first check to see if there is another underlying cause for the symptoms. Some of these conditions may include:
- Precocious puberty
- Congenital adrenal hyperplasia - This is a congenital problem with the production of certain hormones in the adrenal glands.
- Exogenous androgen exposure - for example, from certain types of cosmetics.
- Androgen-secreting tumors.
Your child will undergo a physical exam. At this time, the doctor may want to examine the child's genital area. If they do, they will definitely get consent from you and your child (depending on their age). They may also recommend things like blood tests and imaging tests.
Sometimes, your pediatrician may refer you to a pediatric endocrinologist, a specialist in hormones. Only after all these tests have been done and none of the serious conditions mentioned above have been ruled out will your child be diagnosed with adrenal insufficiency.
It is important to know that about 90% of cases of premature pubic hair in children are caused by this condition called adrenal insufficiency. The other 10% are caused by the other medical conditions mentioned above.
Is Premature Adrenarche Dangerous?
As a parent, it's normal to feel a little nervous and scared when your child's armpit and pubic hair appear earlier than expected, or when they start to smell like sweat. However, premature adrenocortical insufficiency is not usually a physically dangerous condition.
However, research has shown that this condition may slightly increase the risk of developing certain health problems in the future. Some of these problems include:
- Obesity
- Insulin resistance - This means that the body's cells do not respond properly to insulin, which can lead to a predisposition to diabetes.
- Polycystic ovary syndrome (PCOS) - This is a hormonal condition in girls that causes small cysts to form on the ovaries.
- Mood disorders - that is, changes in mood, such as sadness, anxiety, etc.
In addition to these physical risks, precocious puberty can also affect a child's mental health. Imagine, when a child experiences early changes in their body, unlike other children of their age, they may feel embarrassed, uncomfortable, and feel different and strange. They may also be teased by other children (bullying) and receive unwanted attention from others. If you see that your child is feeling sad or anxious about something like this, it is a good idea to seek advice from a qualified person, such as a child psychologist.
Is there a treatment for premature adrenarche?
No. Once hair starts growing in the private area or armpits, there is currently no treatment that can stop it or regrow it.
Although there are some medications that can help control the hormonal process in a condition called precocious puberty, these medications do not affect the hormones related to the adrenal glands.
Can Premature Adrenarche be prevented?
This is usually not something that can be prevented. However, research has found that certain factors may increase a child's risk of developing adrenal insufficiency. Some of these factors include:
- Being born with very low birth weight (weighing less than 2.5 kilograms, or 5 pounds 8 ounces, at birth).
- Preterm birth (birth before 37 weeks of pregnancy).
- If there has been a history of brain injury, this type of brain injury also increases the risk of precocious puberty.
Finally, things to know
As parents, it's normal to feel a little anxious and overwhelmed when you see your child gradually grow and reach puberty, especially when you see those physical changes earlier than expected.
However, the most important thing you need to know is that adrenarche and the accompanying pubarche are natural, normal processes that occur in every child's life.
Premature adrenarche can be alarming, but remember, it usually does not cause significant physical harm to the child.
If you have any doubts or questions about your child's development or changes in their body, please do not hesitate to consult your pediatrician. The doctor will be able to examine your child and explain to you whether he or she is developing healthily and as expected.
` Adrenarche, Adrenarche, DHEA, Puberty, Pubarche, Premature Puberty, Premature Adrenarche, Child Health, Hormones, Child Development
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