SAT-241 - Determinants of Pubertal Progression and Final Height in Premature Pubarche

Background: Premature pubarche (PP) results from early activation of adrenal androgen secretion and is most commonly reflected by elevated plasma dehydroepiandrosterone sulfate (DHEA-S) levels. PP is generally a benign condition; a small proportion of cases may progress to central precocious puberty (CPP). Previous studies have reported that children with PP typically reach a final height (FH) consistent with their genetic potential (midparental height; MPH, target height; TH). Data on the factors determining pubertal tempo and growth outcomes in these individuals are limited.

Aim: To investigate the effect of baseline clinical and biochemical characteristics on FH in girls diagnosed with PP and to evaluate growth outcomes in those who progressed to CPP (PP-to-CPP).

Methods: This retrospective study included 88 girls diagnosed with PP, 13 of whom progressed to CPP and received GnRHa treatment) who achieved their FH during follow-up. Auxological data, bone age, pubertal development, and androgen profiles were evaluated.

Results: At presentation, height corrected for MPH (corrected height; CH) SDS in girls with PP was positively correlated with bone age (BA) SDS and the BA/chronological age (BA/CA) ratio (p=0.03, 0.007; respectively). Corrected FH-SDS was positively associated with baseline CH-SDS in both PP and PP-to-CPP groups (p < 0.001, 0.0002; respectively). PP-to-CPP group had significantly higher baseline CH-SDS (p= 0.02), as well as higher BA-SDS and BA/CA ratio at presentation (p= 0.02) compared with PP group. The mean age at menarche was 11.76 ± 0.95 and 12.02 ± 0.91 years in the PP and PP-to-CPP groups, respectively. Despite the earlier timing of menarche, FH-SDS did not differ from MPH-SDS in the PP group (p=0.12). A higher FH-SDS relative to MPH-SDS observed in the PP-to-CPP group (p= 0.04). In multiple linear regression analysis, baseline CH-SDS emerged as the strongest independent predictor of corrected FH-SDS (p < 0.001). BMI-SDS showed a negative association with FH (p=0.003), whereas bone age advancement and, DHEA-S levels were not independently associated with final height outcomes. Baseline DHEA-S and androstenedione concentrations were not associated with CH-SDS, BA advancement, pubertal progression to CPP, or corrected FH-SDS.

Conclusion: Early growth patterns and skeletal maturation, rather than adrenal androgen concentrations, are the main determinants of pubertal progression and FH outcomes in girls with PP. Higher baseline CH-SDS, advanced BA or increased BA/CA ratio emerge as key early markers of progression to CPP. Importantly, with appropriate treatment and follow-up, girls who progress to CPP can achieve FH comparable to or exceeding their genetic target height.

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