[Does adrenarche really play a determining role in pubertal development? A study of the dissociations between adrenarche and gonadarche. The failure of dehydroepiandrosterone sulfate treatment in delayed adrenarche].

The temporal events of adrenarche (prepubertal shift in adrenal androgen biosynthesis) are described. The mechanisms responsible for the initiation and maintenance of the adrenal secretion of androgens are poorly understood. The hypotheses put forward to explain it are reviewed. The transectional or longitudinal study of the plasma levels of dehydroepiandrosterone, its sulfate (DHAS), delta 4-androstenedione, testosterone, and 170H-progesterone in 121 children with a variety of clinical disorders in which adrenarchal and gonadal maturations are dissociated (precocious adrenarche, precocious or delayed puberty, adrenal insufficiency, gonadal dysgenesis, hypogonadotropism hypogonadotrophic) is presented. Treatment of a group of 10 children, with delayed or absent adrenarche and growth failure, with DHAS at physiological dose, for a mean of two years, failed to induce any change in growth rate, bone maturation, growth of sexual hair, or genitalia, or to advance puberty. A physiological role for adrenal androgens remains to be discovered. The author's concept is that adrenarche represents a "marker of body maturation".