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Premature adrenarche unlikely to confer cardiometabolic risk in women
Decreased insulin sensitivity observed in a cohort of women with premature adrenarche in childhood is likely associated with increased central adiposity and not prepubertal factors, according to a case-control analysis published in the Journal of the Endocrine Society.
Premature adrenarche has been associated with an increased prepubertal BMI and hyperinsulinemia, as well as an unfavorable lipid profile orslightly increased blood pressure in prepubertal girls, Jani Liimatta, MD, PhD, of the department of pediatrics at Kuopio University Hospital, Finland, and colleagues wrote in the study background.
“A tendency to be overweight and hyperinsulinemic seems to persist at least until early puberty, and it has been suggested that [premature adrenarche] is a risk factor for the development of later cardiometabolic abnormalities, such as the metabolic syndrome,” the researchers wrote. “However, the number of previous studies exploring long-term cardiovascular risk profile and adult outcomes of [premature adrenarche] is limited.”
Liimatta and colleagues analyzed data from 30 women with premature adrenarche and 41 controls, followed from prepuberty (median age at exam, 7.6 years) to young adulthood with clinical exams at median age of 18 years. Primary outcome was the prevalence of the metabolic syndrome and clinical and biochemical CV risk factors.
The researchers observed no between-group differences in the prevalence of metabolic syndrome or in any parameters indicating dyslipidemia, hypertension, hepatosteatosis, atherosclerosis or low-grade inflammation. However, women with premature adrenarche had a higher prevalence of insulin resistance (P = .014) and acanthosis nigricans (P = .01), according to researchers. Most women with premature adrenarche had overweight or obesity (62%). Fasting glucose and insulin concentrations did not differ between groups, although women with premature adrenarche had a higher HbA1c vs. controls (BMI-adjusted P = .011) and greater insulin resistance as measured by homeostatic model assessment of insulin resistance that did not rise to significance once adjusted for BMI.
BMI and fat percentage were comparable between the study groups; however, women with premature adrenarche had higher central fat mass vs. controls, according to researchers. Overall, both metabolic syndrome and insulin resistance were associated with higher adult fat mass. No prepubertal factors predicted later insulin resistance.
“Cardiometabolic risk can be deduced largely from the sum of the components of [metabolic syndrome], and our study suggests that [premature adrenarche] does not associate with [metabolic syndrome] at young adult age,” the researchers wrote.
The researchers noted that the women did not undergo a postpubertal oral glucose tolerance test, which could have provided more precise information on glucose metabolism and insulin resistance.
“Our study suggests that some [premature adrenarche] females may be at risk of having decreased insulin sensitivity at young adult age,” the researchers wrote. “Maintaining or gaining increased central adiposity by adulthood seems to be a major independent determinant for this risk, rather than [premature adrenarche] or other prepubertal factors related to [premature adrenarche].” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.