Finding early biomarkers to prevent unfavorable long-term health outcomes after premature adrenarche (FinAdmiR)

Before puberty, children go through a pre-pubertal phase known in medicine as ”adrenarche” (”adren” = adrenal gland and ”arche” = beginning). Adrenarche marks the start of adrenal gland maturation, during which the adrenal cortex becomes active and begins producing increasing amounts of sex hormones. These hormones lead to early physical changes, such as adult-type body odor, increased oiliness of skin and hair, acne, and the growth of hair in the underarm and pubic areas.

The clinical signs of adrenarche typically appear when girls are over 8 years old and boys over 9. In some children, however, adrenarche begins earlier than usual, a phenomenon known as ”premature adrenarche.” Most cases of premature adrenarche do not lead to significant health issues. However, there is evidence that some children who experience early adrenarche may have a higher risk of developing adult health problems, such as obesity, abnormal glucose metabolism, and fertility issues.

In science, (premature) adrenarche is still considered an unsolved mystery. We still do not know which factors trigger or promote the early maturation of the adrenal glands, and doctors currently lack tools to differentiate children with premature adrenarche who may be at risk for later health problems from those who are not. This identification would be important for closer monitoring and potential early medical support, while avoiding unnecessary concern or stigma for those without future health risks.

The FinAdmiR study aims to better understand the regulation of adrenal maturation and to find new indicators that doctors may use in the future to assess the risk of later health problems associated with premature adrenarche.

The study is a long-term follow-up study conducted with voluntary participants, beginning when the child is around 5–9 years old and continuing into early adulthood (the final planned follow-up visit at age 18). In addition to the initial visit, children are invited to participate at key points in their developmental timeline, including the onset of adrenarche, various stages of puberty, and eventually early adulthood. The study seeks children who have symptoms that suggest or indicate premature adrenarche (case group), as well as healthy children with typical timing of adrenarche (control group). The study lasts a total of 10–12 years, with follow-up visits held at the facilities of the University of Eastern Finland and Kuopio University Hospital: children with premature adrenarche will attend five study visits, while those in the control group will attend six visits.

Each study visit, conducted by a pediatrician and a research nurse, includes a clinical examination (measuring height, weight, and blood pressure), an ultrasound examination of the gonads, body composition assessment with an InBody device (without radiation), and a blood sample. Participants will also provide saliva and hair samples as well as a 24-hour urine collection sample. During the first visit, we will gather background information about the child and family as well as lifestyle details through questionnaires. Each visit takes approximately four hours, and participants should arrive on an empty stomach for blood sampling. Breakfast will be provided after the blood sample.

The study has been granted organizational approval from the Wellbeing Services County of North Savo as well as a favorable opinion from the Research Ethics Committee. All collected information will be handled confidentially.