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This version published online on November 21, 2006
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2006-2002
A more recent version of this article appeared on February 1, 2007
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Submitted on September 12, 2006
Accepted on November 13, 2006

Obesity and Sex Steroid Changes Across Puberty: Evidence for Marked Hyperandrogenemia in Pre- and Early Pubertal Obese Girls

Christopher R. McCartney*, Susan K. Blank, Kathleen A. Prendergast, Sandhya Chhabra, Christine A. Eagleson, Kristin D. Helm, Richard Yoo, R. Jeffrey Chang, Carol M. Foster, Sonia Caprio, and John C. Marshall

The Center for Research in Reproduction; Division of Endocrinology, Department of Internal Medicine; University of Virginia Health System, Charlottesville, Virginia 22908. Division of Reproductive Endocrinology and Infertility, Department of Reproductive Medicine, University of California, San Diego, California 92103. Division of Endocrinology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108. Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States, 06520

* To whom correspondence should be addressed. E-mail: cm2hq{at}virginia.edu.

Context: Peripubertal obesity is associated with abnormal sex steroid concentrations, but the timing of onset and degree of these abnormalities remain unclear.

Objective: To assess the degree of hyperandrogenemia across puberty in obese girls, and to assess overnight sex steroid changes in Tanner 1-3 girls.

Design: Cross-sectional analysis.

Setting: General Clinical Research Centers.

Subjects: Thirty normal weight (BMI-for-age < 85%) and 74 obese (BMI-for-age ≥ 95%) peripubertal girls.

Intervention: Blood samples (circa 0500-0700 h) while fasting. Samples from the preceding evening (circa 2300 h) were obtained in 23 Tanner 1-3 girls.

Main outcome measures: Hormone concentrations stratified by Tanner stage.

Results: Compared with normal weight girls, mean free testosterone (T) was elevated 2- to 9-fold across puberty in obese girls, while fasting insulin was 3-fold elevated in obese Tanner 1-3 girls (P < 0.05). Mean LH was lower in obese Tanner 1 and 2 girls (P < 0.05), but not in more mature girls. In a subgroup of normal weight Tanner 1-3 girls (n = 17), mean progesterone (P) and T increased overnight 2.3- and 2.4-fold, respectively (P ≤ 0.001). In obese Tanner 1-3 girls (n = 6), evening P and T were elevated, and both tended to increase overnight (mean 1.4- and 1.6-fold, respectively [P = 0.06]).

Conclusions: Peripubertal obesity is associated with hyperandrogenemia and hyperinsulinemia throughout puberty, being especially marked shortly before and during early puberty. Progesterone and testosterone concentrations in normal weight Tanner 1-3 girls increase overnight, with similar but less evident changes in obese girls.
Key words: hyperandrogenemia • testosterone • progesterone • estradiol • PCOS • puberty • adolescence • obesity • adiposity • overweight • hyperinsulinemia • insulin • LH




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