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September 29, 2003

Puberty

Question from Passaic, New Jersey, USA:

My son has type 1 diabetes. During his physical examination, my son's pediatric endocrinologist smells my son's armpits. Any idea what he is checking for?

Answer:

Absolutely! Your son’s endocrinologist is assessing for evidence of adrenarche — the production of androgens (male hormones) from the adrenal glands. Biochemically, adrenarche can precede “true” pituitary-gonadal puberty, although physical features (pubic and underarm hair) typically manifest later.

Androgens plus sweat plus bacteria lead to the (shall we say) typical aroma of the sexually maturing young person. If this happens to early (regardless of a diagnosis of diabetes) that can herald some potential health threatening issues, but usually premature adrenarche is benign. However, pubertal hormones can raise havoc with diabetes — given the inherent insulin-resisting effects of sex-steroids plus the appetite and growth spurts and changes in sleep patterns that typically accompany puberty. No need to be embarrassed about asking this. I think your son’s endocrinologist would be pleased to explain all the reasons for the endocrine exam.

DS
Additional comments from Dr. Larry Deeb:

I expect signs of puberty.

LD
Additional comments from Dr. Tessa Lebinger:

He’s probably checking for axillary odor, which can be the first sign of puberty and is caused by the same hormones that cause the hair under the arms, acne, and pubic hair (various “androgens”). This can be triggered in males first either by the adrenal gland (“adrenarche”) or by the testicles (“gonadarche”). When the testicles start to enlarge as they produce more hormones, the growth rate should start to increase (and you usually also see increased food and insulin requirements.)

It is very important to monitor the progression of puberty and growth in children with diabetes, as either poor control and/or thyroid dysfunction can cause abnormalities in the progression of puberty or growth.

TGL
Additional comments from Dr. Andrea Scaramuzza:

Perhaps he would like to know if your son is near puberty. In fact, one of the first sign of puberty might be the maturation of sudoriferous glands that can produce a sweat with a typical odour just during puberty or the period immediately before.

AS
Additional comments from Dr. Stuart Brink:

I have no idea why someone would smell armpits. If he is interested in puberal status, it’s easier to ask if there is body odor detected by patient and/or patients, if deodorant is needed, etc. Why don’t you ask the physician why this is being done?

SB