Premature adrenarche refers to the appearance of public hair before age 8 years in girls and 9 years in boys, without other signs of puberty or virilization. Growth velocity may be increased and slightly advanced bone maturation is often present and is usually well correlated with the height age. The transient acceleraration of growth and of bone maturation have no negative effects on the onset and progression of puberty, and on final height. The diagnosis is based on the exclusion of the different forms of hyperandrogenism such as precocious puberty, late-onset congenital adrenal hyperplasia, virilizing tumors, glucocorticoid resistance, and Cushing syndrome. Once the diagnosis is made, no treatment is needed. However, a long-term follow-up of these patients is warranted. Recent data, in fact, indicate that girls with premature adrenarche may not have a benign outcome. Postpubertal girls with premature adrenarche during childhood have an increased frequency of functional ovarian hyperandrogenism. Furthermore, hyperinsulinemia is a common feature in adolescent patients with premature adrenarche and functional ovarian hyperandrogenism, and appears to be directly realted to the degree of androgen excess. Although the mechanisms interlinking the triad of premature pubarche, hyperinsulinemia and ovarian hyperandrogenism remain enigmatic, this frequent concurrence may result, at least in part, from a common early origin rather than from a direct interrelationship later in life.