DHEA 1. 87 ng/ml ( PUBIC HAIR AT AGE OF

Early pubic hair (pubarche) in a 6-year-old may be a sign of premature adrenarche, which is often benign but needs monitoring. A DHEA level of 1.87 ng/mL is within or near the upper end of the normal range for a child of that age. However, values can vary slightly by lab. Recommendations: 1. Yes, follow up with the pediatric endocrinologist, especially since this is a recurring concern. 2. A bone age X-ray may help assess if puberty is progressing faster than normal. 3. Continue monitoring for: Rapid height gain Body odor Breast development or other signs of puberty 4. No specific dietary changes are usually needed unless advised, but continuing with healthy habits is good.

Hormonal Blood Tests These help rule out early puberty or adrenal disorders: DHEA-S (Dehydroepiandrosterone sulfate) Androstenedione 17-Hydroxyprogesterone (to rule out late-onset CAH) LH (Luteinizing Hormone) and FSH (Follicle-Stimulating Hormone) — baseline and possibly after a GnRH stimulation test Estradiol — to assess early estrogen exposure Testosterone — though low in girls, it may be elevated in some conditions Cortisol — if signs of Cushing’s are present TSH and free T4 — to rule out thyroid abnormalities 2. Bone Age X-ray Left hand and wrist X-ray — checks if bone maturation is ahead of chronological age, a key indicator of early puberty. 3. Pelvic Ultrasound Evaluates uterine and ovarian size — enlarged size may suggest true central puberty. 4. ACTH Stimulation Test If 17-OHP is borderline or raised, this can help diagnose non-classic congenital adrenal hyperplasia (CAH). 5. Monitoring Growth Velocity Accurate height tracking over months helps identify abnormal growth acceleration.