背景:Adrenarche标志着人类肾上腺发育的时间点,当皮质开始分泌越来越多的雄激素时,在8-9岁的健康儿童中,早熟的肾上腺素(PA)。因为肾上腺素的分子调控和意义是未知的,这种青春期前事件的特征是描述性的,PA是一种排除诊断,长期后果不明确。
方法:我们搜索了过去五年的文献,包括原创文章,reviews,和来自PubMed的荟萃分析,ScienceDirect,WebofScience,Embase,还有Scopus,使用搜索词“肾上腺素”,\"pubarche\",\"DHEAS\",“类固醇生成”,“肾上腺”,和“网状带”。
结果:许多研究涉及肾上腺素和PA的不同主题。虽然人类肾上腺发育的基础研究,分区和网状带功能增强了我们的知识,导致肾上腺素的确切机制仍未解决。许多监管机构似乎参与其中。在11-氧雄激素途径中发现了肾上腺素(11-酮雌酮)的有希望的标记。根据目前的定义,PA的患病率在女孩中可以高达9-23%,在男孩中可以高达2-10%。但这些儿童中只有一部分可能面临相关的不良健康结果.
结论:需要定义肾上腺和PA的新标准,以确定有后期疾病风险的儿童和具有正常变异的儿童。因此,需要进一步的研究来了解肾上腺素。前瞻性,长期研究应描述调节出生大小轨迹的产前或出生后早期发育途径,出生后早期生长,儿童超重/肥胖,肾上腺素和青春期开始,导致异常的性成熟,生育力,和其他不良后果。
BACKGROUND: Adrenarche marks the timepoint of human adrenal development when the cortex starts secreting androgens in increasing amounts, in healthy children at age 8-9 years, with premature adrenarche (PA) earlier. Because the molecular regulation and significance of adrenarche are unknown, this prepubertal event is characterized descriptively, and PA is a diagnosis by exclusion with unclear long-term consequences.
METHODS: We searched the literature of the past 5 years, including original articles, reviews, and meta-analyses from PubMed, ScienceDirect, Web of Science, Embase, and Scopus, using search terms adrenarche, pubarche, DHEAS, steroidogenesis, adrenal, and zona reticularis.
RESULTS: Numerous studies addressed different topics of adrenarche and PA. Although basic studies on human adrenal development, zonation, and zona reticularis function enhanced our knowledge, the exact mechanism leading to adrenarche remains unsolved. Many regulators seem involved. A promising marker of adrenarche (11-ketotestosterone) was found in the 11-oxy androgen pathway. By current definition, the prevalence of PA can be as high as 9% to 23% in girls and 2% to 10% in boys, but only a subset of these children might face related adverse health outcomes.
CONCLUSIONS: New criteria for defining adrenarche and PA are needed to identify children at risk for later disease and to spare children with a normal variation. Further research is therefore required to understand adrenarche. Prospective, long-term studies should characterize prenatal or early postnatal developmental pathways that modulate trajectories of birth size, early postnatal growth, childhood overweight/obesity, adrenarche and puberty onset, and lead to abnormal sexual maturation, fertility, and other adverse outcomes.