Endocrine Unit, Metropolitan Hospital, Ermou 6, 10563, Athens, Greece.
Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital of Zurich, Zurich, Switzerland.
Curr Pharm Des. 2020;26(43):5609-5616. doi: 10.2174/1381612826666201012164726.
Early activation of the adrenal zona reticularis, leading to adrenal androgen secretion, mainly dehydroepiandrosterone sulfate (DHEAS), is called premature adrenarche (PA). The fact that adrenal hyperandrogenism in females has been linked to a cluster of cardiovascular (CV) risk factors, even in prepubertal children, warrants investigation. Controversial results have been obtained in this field, probably due to genetic, constitutional, and environmental factors or differences in the characteristics of participants. In an attempt to understand, in depth, the impact of PA as a potential activator of CV risk, we critically present available data stratified according to pubertal status. It seems that prepubertally, CV risk is increased in these girls, but is somewhat attenuated during their second decade of life. Furthermore, different entities associated with PA, such as polycystic ovary syndrome, non-classical congenital adrenal hyperplasia, heterozygosity of CYP21A2 mutations, and the impact of DHEAS on CV risk, are reviewed. At present, firm and definitive conclusions cannot be drawn. However, it may be speculated that girls with a history of PA display a hyperandrogenic hormonal milieu that may lead to increased CV risk. Accordingly, appropriate long-term follow-up and early intervention employing a patient-oriented approach are recommended.
肾上腺网状带的早期激活导致肾上腺雄激素分泌，主要是硫酸脱氢表雄酮（DHEAS），这种现象被称为早发性肾上腺皮质功能亢进症（PA）。女性的肾上腺性高雄激素血症与一系列心血管（CV）危险因素有关，即使在青春期前的儿童中也是如此，这值得进一步研究。由于遗传、体质和环境因素或参与者特征的差异，该领域的研究结果存在争议。为了深入了解 PA 作为潜在 CV 风险激活剂的影响，我们根据青春期状态对现有数据进行了批判性评估。在青春期前，这些女孩的 CV 风险似乎增加，但在她们生命的第二个十年中会有所减弱。此外，还回顾了与 PA 相关的不同实体，如多囊卵巢综合征、非经典先天性肾上腺皮质增生、CYP21A2 基因突变的杂合性以及 DHEAS 对 CV 风险的影响。目前，无法得出确凿和明确的结论。然而，可以推测有 PA 病史的女孩表现出一种可能导致 CV 风险增加的高雄激素激素环境。因此，建议采用以患者为中心的方法进行适当的长期随访和早期干预。
