Choosing Wisely:

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.
Sponsoring Organizations:
  • American Academy of Pediatrics – Section on Endocrinology
  • Sources:
  • American Academy of Pediatrics guidelines
  • Disciplines:
  • Endocrinologic
  • Pediatric
  • References: • Kaplowitz P, Bloch C, the SECTION ON ENDOCRINOLOGY. Evaluation and Referral of Children with Signs of Early Puberty. Pediatrics. 2016;137(1):e20153732.

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