Sir.—Adams et al1 described three infant girls with premature pubarche and suggested that one infant (patient 3) may have had nonclassic 3β-hydroxysteroid deficiency based on corticotropin stimulation test results (the ratio of stimulated Δ5-17-hydroxypregnenolone [17-OHPreg] to 17-hydroxyprogesterone [17-OHP] of 11.6 at age 3 months). They also reported slightly elevated 17-OHPreg levels and 17-OHPreg-17-OHP ratios in the other two infants. Normal values for prepubertal children were referenced.
I wish to bring to the authors' attention more age-specific normative corticotropin stimulation data recently published.2 These newer data demonstrate significantly higher baseline and stimulated 17-OHPreg and 17-OHPreg-17-OHP ratios in infants (<1 year; n=21) than in older prepubertal children. The reported mean (±SD) stimulated 17-OHPreg-17-OHP ratio in normal infant girls (n=8) was 12.1±6.2. Thus, the stimulated 17-OHPreg-17-OHP ratio of 11.6 in patient 3 lies well within the normal range for age.
The apparent decreased 3β-hydroxysteroid activity in normal infancy
MORRIS AH. Pubic Hair in Infancy. Am J Dis Child. 1992;146(10):1132. doi:10.1001/archpedi.1992.02160220018009