Introduction: Type 2 diabetes mellitus (T2DM) is more aggressive when diagnosed in childhood, and its incidence continues to rise. Premature adrenarche (PA) is often considered benign; however, emerging data suggest a complex interplay among subsequent hyperandrogenism, obesity, and insulin resistance. Our objective was to determine whether PA in childhood is a risk factor for future youth-onset prediabetes (PreDM) or T2DM. Methods: We conducted a retrospective chart review from 2011-2022 of youth diagnosed with benign PA, with subsequent assessment for PreDM or T2DM. Results: There were 229 patients with PA identified (60 males, 169 females), of whom 82% were overweight or obese at PA diagnosis. Follow-up hemoglobin A1c (HbA1c) were available for 90 patients (24 males, 66 females). Among these, 38% of both males and females developed PreDM, while 8% of males and 6% of females developed T2DM, yielding an overall dysglycemia frequency of 44%. In males, those with PreDM were more likely to be of Non-Hispanic Black race/ethnicity compared to those with normal HbA1c (p=0.31). In females, height, weight, and BMI at initial PA evaluation were higher in those who later developed PreDM compared to those with normal HbA1c (all p < 0.01). Conclusions: Compared with national estimates, we observed youth with PA demonstrated higher frequency of dysglycemia and obesity. While prior studies have shown increased insulin resistance in PA compared to all youth with obesity, this study is the first to demonstrate higher rates of subsequent youth-onset T2DM in this population. These findings support close longitudinal monitoring for dysglycemia in children with PA.
Thomas et al. (Sun,) studied this question.