Levels of adrenal androgen, dihydroepiandrosterone (DHEA) and dihydroepiandrosterone sulphate (DHEAS) rise in plasma before pubertal development or before gonadotrophin secretion increases (Fig. 13.11). The driving force of this rise is unknown, but adrenocorticotrophic hormone (ACTH) is necessary. This process of increasing adrenal androgen concentrations is known as adrenarche. In premature adrenarche the rise occurs early, so that DHEAS and DHEA concentrations in a six- to eight-year-old boy may be equal to those found in normal boys at midpuberty.
