Palmert M R, Hayden D L, Mansfield M J, Crigler J F, Crowley W F, Chandler D W, Boepple P A
Division of Endocrinology, Department of Medicine, Children's Hospital, Boston, Massachusetts 02115, USA.
J Clin Endocrinol Metab. 2001 Sep;86(9):4536-42. doi: 10.1210/jcem.86.9.7863.
The physical changes that herald the onset of puberty result from the combination of adrenarche and gonadarche. To examine adrenal maturation and associated changes in growth without the confounding effects of changes in the gonadal steroid milieu, we performed a longitudinal study in 14 young girls with idiopathic central precocious puberty during long-term pituitary-gonadal suppression. Beginning at the mean age of 2.9 yr, dehydroepiandrosterone sulfate levels, linear growth, skeletal maturation, body mass index, and secondary sexual development were evaluated at 3- to 6-month intervals for up to 12.3 yr. In 12 of the girls, levels of dehydroepiandrosterone, androstenedione, 17-hydroxypregnenolone, and 17alpha-hydroxyprogesterone were determined before and after acute ACTH stimulation every 6 months to investigate the maturation of adrenal steroidogenic enzyme activity. Serum dehydroepiandrosterone sulfate levels rose progressively throughout the study. An exponential model fit the longitudinal datasets well and indicated that dehydroepiandrosterone sulfate levels increased approximately 22%/yr from the youngest age onward. Increasing activity of 17-20 lyase (CYP17) and decreasing activity of 3beta-hydroxysteroid dehydrogenase were also evident in preadrenarchal subjects. When controlled for chronological age, no significant associations were noted between weight, body mass index, or body surface area and dehydroepiandrosterone sulfate levels. However, similar analyses revealed modest correlations of both height and growth velocity with dehydroepiandrosterone sulfate levels. Our results suggest that adrenarche is not the result of sudden rapid changes in adrenal enzyme activities or adrenal androgen concentrations; rather, adrenarche may be a gradual maturational process that begins in early childhood.
青春期开始时出现的身体变化是肾上腺初现和性腺初现共同作用的结果。为了在不考虑性腺类固醇环境变化的混杂影响的情况下，研究肾上腺成熟及相关的生长变化，我们对14名患有特发性中枢性性早熟的年轻女孩进行了一项长期垂体-性腺抑制期间的纵向研究。从平均2.9岁开始，每3至6个月评估硫酸脱氢表雄酮水平、线性生长、骨骼成熟、体重指数和第二性征发育，最长达12.3年。在12名女孩中，每6个月在急性促肾上腺皮质激素刺激前后测定脱氢表雄酮、雄烯二酮、17-羟孕烯醇酮和17α-羟孕酮水平，以研究肾上腺类固醇生成酶活性的成熟情况。在整个研究过程中，血清硫酸脱氢表雄酮水平逐渐升高。指数模型很好地拟合了纵向数据集，表明从最年幼时起，硫酸脱氢表雄酮水平每年大约增加22%。在肾上腺初现前的受试者中，17 - 20裂解酶（CYP17）活性增加和3β-羟基类固醇脱氢酶活性降低也很明显。在按实足年龄进行校正后，体重、体重指数或体表面积与硫酸脱氢表雄酮水平之间未发现显著关联。然而，类似分析显示身高和生长速度与硫酸脱氢表雄酮水平均存在适度相关性。我们的结果表明，肾上腺初现并非肾上腺酶活性或肾上腺雄激素浓度突然快速变化的结果；相反，肾上腺初现可能是一个从幼儿期就开始的渐进成熟过程。
