Urinary steroid metabolomics, body composition and metabolic risk in children with premature adrenarche

Said Wogud Ben; Ruth Krone; Shakila Thangaratinam; Wiebke Arlt; Ameshbabu Asha Marichetty; Jan Idkowiak

doi:10.1530/endoabs.111.P78

P78

Prev Next

Section Contents Cite

Endocrine Abstracts (2025) 111 P78 | DOI: 10.1530/endoabs.111.P78

BSPED2025 Poster Presentations Adrenal 2 (9 abstracts)

Urinary steroid metabolomics, body composition and metabolic risk in children with premature adrenarche

Wogud Ben Said ^1,2,3,4 , Ruth Krone ^2,3 , Shakila Thangaratinam ⁵ , Wiebke Arlt ⁶ , Asha Marichetty Ameshbabu ^3,7 & Jan Idkowiak ^2,1,3,4

Author affiliations

¹Department of Metabolism and Systems Science, University of Birmingham, Birmingham, Birmingham, United Kingdom; ²Department of Endocrinology and Diabetes, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom; ³Birmingham Biomedical Research Centre, Women’s Metabolic Health Theme, University of Birmingham, Birmingham, United Kingdom; ⁴Birmingham Health Partners, University of Birmingham, Birmingham, United Kingdom; ⁵Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom; ⁶UKRI MRC London Institute of Medical Sciences, London, United Kingdom; ⁷NIHR/Wellcome Trust Clinical Research Facility, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom

Background: Premature adrenarche (PA) is a common presentation in pre-pubertal children and mostly occurs in girls before their 8th birthday. There is controversy about whether children with PA are at higher risk of developing metabolic complications or may progress to developing Polycystic Ovary Syndrome (PCOS) in later life.

Aim: We aim to characterise a phenotypic, hormonal and biochemical metabolic risk signature in cohorts of children with PA.

Design and Methods: Single-centre case-control study in children with PA and PCOS, matched to healthy volunteers. We assessed auxology, (height, weight, BMI [z-score], waist-to-hip/length ratio, dual-energy X-ray-absorptiometry), fasting hormonal (DHEAS, androstenedione, testosterone, SHBG, prolactin, IGF-1), 24-hour urinary steroid profiling, and standard metabolic risk markers (lipid profile, HbA1c, glucose).

Results: 68 PA children (58 girls, 10 boys; age: 7.7 years, range 4.4-9.9) and 30 healthy controls (18 girls, 10 boys; age: 7.7 years, range 4.5-10.3) were included; precocious puberty, and congenital adrenal hyperplasia were excluded. Weight, BMI and BMI z-score were significantly higher in PA compared to controls. Androgens were also significantly higher in PA: DHEAS (median 2.87 [IQR 2.01-3.38] vs 1.08 mcmol/l [0.7-1.73]; P < 0.001), androstenedione (1.2 [0.85-1.6] vs 0.75 [0.58-1.43] nmol/l; P = 0.023) and testosterone (0.3 [0.2-0.3] vs 0.15 [0.1-0.225] nmol/l; P = 0.0015). We also observed significantly lower fasting HDL cholesterol (1.50 [1.4-1.6] vs. 1.40 [1.2-1.5] mU/l; P = 0.033) and SHBG (61 [45.25-90.75] vs 88 [62-119] nmol/l; P = 0.0219). Urinary androgen metabolites An, Et, DHEA, and 5PT are higher in PA compared to controls. IGF1 was higher in PA compared to controls (30.1 [26-35.9] vs. 17.7 [13.9-24.4] mmol/l; P < 0.0001). There was a mild association between PT and fasting glucose in PA. We did not observe any significant differences between PA and controls for HbA1c, triglycerides, total/ LDL cholesterol and prolactin.

Summary and Conclusion: Children with PA are heavier and taller, they have higher IGF1 adrenal androgen production. Recruitment is ongoing, and more in-depth biochemical assessment, such as fasting insulin/ HOMA-IR (B) and multi-steroid profiling, may help to identify metabolic risk parameters.