AR and hyperandrogenism: The etiology of premature adrenarche remains unknown.1,33 Several possible contributing factors have been speculated, including intra-adipose tissue activation of androgens leading to androgen excess, heritably elevated DHEAS levels, and polymorphic variations of the androgen receptor.1,34–36 The lack of a clear pathophysiology suggests that different etiologies may coexist, leading to subgroups within children diagnosed with PA.