Avoid ordering luteinizing hormone- and follicle-stimulating hormone and either estradiol or testosterone for children with pubic hair and/or body odor but no other signs of puberty.
|Rationale and Comments:||Premature adrenarche is usually the diagnosis and does not involve activation of the pituitary-gonadal axis but is due to an early increase in adrenal androgens. DHEA-S levels are elevated for age but do not alter the management of this common and generally benign condition.|
|References:||• Kaplowitz P, Bloch C, the SECTION ON ENDOCRINOLOGY. Evaluation and Referral of Children with Signs of Early Puberty. Pediatrics. 2016;137(1):e20153732.