Some children have elevated adrenal androgens years before the normal age of onset of adrenarche and experience pubic hair development, some axillary hair development, and even some acne years before the normal age of onset of normal puberty; this is apparently a normal variation of the normal onset of adrenarche (Fig. 13.40). With the recent description of late-onset congenital adrenal hyperplasia, it is sometimes difficult to determine whether the patient has bona fide premature adrenarche or another genetic condition that is affecting the adrenal gland. Nonetheless, in premature adrenarche DHEAS is elevated to earlier midpubertal levels, and is useful for diagnosis of the condition.
