ACTH STIMULATION TESTS IN GIRLS WITH PREMATURE PUBARCHE

Abstract

Premature pubarche (PP) may be due to mild errors of adrenal steroidogenesis due mainly to a deficiency of 21-hydroxylase. However, there is controversy regarding whether all children should undergo an ACTH test in order to differentiate nonclassical congenital adrenal hyperplasia (NCAH) from other causes of PP. An ACTH stimulation test (0.25 mg/IV) with blood sampling both basally and at 60 min was performed in 29 girls with FP. Four patients had acne, 3 had clitoral enlargement and 2 had advanced bone age. Their chronological age was 5.7 ± 1.3 yr, their bone age was 7.7 ± 1.3 yr with an advance of 0.8 ± 0.7 yr, and the height age was 7.3 ± 1.3 yr. Cortisol was normal with elevated baseline levels of 17OHP (69%), ANDRO (68%), DHEAS (64%) and TESTO (21%). The patients were subdivided into 3 groups (G) based on their levels of 17OHP during the ACTH test.

G1: normal (< 300 ng/dl), n=20; 181.2±76.6 ng/di; · G2: indeterminate (≥ 300 and < 1000 ng/dl), n=7; 435.8 ± 98.4 ng/dl;

G3: NCHA (> 1000 ng/dl), n=2; 3810.7 ± 3910.1 ng/dl. There was a statistical difference between 17OHP at 60 min in G1 and G2, (p < 0.0001). The proportion baseline value > 100 ng/dl among the 3 groups was different (p < 0.005). Clinical findings and bone maturation do not differentiate these groups. We suggest that an ACTH test should be performed only when the 17OHP basal levels exceed 100 ng/dl. In these cases the ACTH stimulation test allows the correct classification of these patients.

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