Estradiol and Pubertal Growth in Girls

Albin, Anna-Karin; Niklasson, Aimon; Westgren, U; Norjavaara, Ensio

doi:10.1159/000343076

Cited by 24 publications

(17 citation statements)

References 56 publications

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“…With this reduced regimen, the risk of too high a serum E 2 concentration, compared to the reference interval for Tanner stage B2, will be reduced. This is also supported by recent results from girls in spontaneous puberty, demonstrating an association of serum E 2 levels of 13-31 pmol/l with increased height velocity or onset of the pubertal growth spurt [3]. …”

Section: Discussionsupporting

confidence: 84%

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Physiological Estrogen Replacement Therapy for Puberty Induction in Girls: A Clinical Observational Study

2014

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Background/Aim: The goal of estrogen replacement therapy (ERT) in girls with hypogonadism is to achieve the endocrine milieu similar to natural puberty, where transdermal administration is the most physiological route. The aim of the study was to evaluate guidelines for the induction of puberty with transdermal estradiol (E₂) patches in a large outpatient setting. Methods: In a retrospective study, serum E₂ levels from 18 clinics were analyzed at the Göteborg Pediatric Growth Research Center laboratory, as part of the initiation of ERT in girls with hypogonadism. Exclusion criteria were pubertas tarda and pubertal arrest. Eighty-eight observations (50 with Turner syndrome, TS) were included. Serum E₂ levels were determined by extraction + radioimmunoassay (detection limit 4 pmol/l) and analyzed in relation to the dose of Evorel® (25 µg/24 h, containing 1.60 mg estradiol hemihydrate; Janssen-Cilag Pharmaceutica N.V., Beerse, Belgium). Results: There was a linear relationship between serum E₂ and the weight-based dose, with r = 0.56, p < 0.0001 for all observations and r = 0.59, p < 0.0001 for the TS study group. Linear regression analysis for doses of 0.05-0.07 µg/kg resulted in serum levels of 17-23 pmol/l (TS 17-24 pmol/l) and doses of 0.08-0.12 µg/kg in 26-39 pmol/l (TS 27-39 pmol/l). Conclusions: For the initiation of ERT with nocturnally administered E₂ patches, we recommend reduced starting doses of 0.05-0.07 µg/kg, with the goal of mimicking E₂ levels during gonadarche. In older girls, when breast development is of high priority, the starting dose can still be 0.08-0.12 µg/kg.

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Section: Discussionsupporting

confidence: 84%

“…The very early part of the pubertal growth spurt and the development of secondary sexual characteristics are regulated by increasing serum levels of nocturnal estrogens, where low serum estrogen levels are growth promoting and higher levels are needed for complete breast and body development [3,4]. …”

Section: Introductionmentioning

confidence: 99%

Physiological Estrogen Replacement Therapy for Puberty Induction in Girls: A Clinical Observational Study

2014

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“…The levels of estradiol close to PHV seen in this study (>9 pmol/l) are the levels we find in the transition from B1 to B2 in girls [27], when their pubertal growth spurt usually starts. The calculated EC 50 of 17β-estradiol in this study is also lower than the corresponding EC 50 in healthy girls published recently, showing a 50% increase in growth velocity from prepuberty to PHV at a morning 17β-estradiol level of 20 pmol/l (13-31) [47]. The important levels of estradiol at the growth plates probably correlate to serum estradiol levels to a higher degree in girls than in boys.…”

Section: Discussioncontrasting

confidence: 61%

Pubertal Growth and Serum Testosterone and Estradiol Levels in Boys

Albin

Norjavaara

2013

Horm Res Paediatr

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Background/Aims: To study serum testosterone and estradiol in healthy boys in relation to growth during puberty up to peak height velocity (PHV). Methods: Growth velocity was analyzed through testosterone (n = 41) and 17β-estradiol (n = 37) 24-hour profiles in a dose-response model. Participants were 26 healthy boys admitted for short or tall stature or participating as healthy volunteers at the Queen Silvia Children's Hospital. Other inclusion criteria included the following: gestational age 37-42 weeks, birth weight and length >-2 standard deviation score (SDS) and prepubertal height and weight within ±3 SDS. Testosterone was measured using a modified radioimmunoassay (RIA) with a detection limit of 0.03 nmol/l. Estradiol was determined using an ultrasensitive extraction RIA with a detection limit 4 pmol/l. A sixth-grade polynomial was fitted to each child's growth data, giving growth velocity and age at PHV. Results: Growth velocity increased by 50% from prepubertal growth to PHV at a morning testosterone level of 3.1 nmol/l (95% confidence interval 2.4-4.2), EC₅₀. The corresponding EC₅₀ of 17β-estradiol was 6.5 pmol/l (3.2-13). Boys approaching PHV (<4% remaining) had morning testosterone levels >10 nmol/l and 17β-estradiol >9 pmol/l. Conclusion: Observed early puberty/initial mid puberty morning testosterone levels of 2.4-4.2 nmol/l are associated with a 50% increase in growth velocity from prepubertal growth to PHV in healthy boys.

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“…Growth acceleration is in line with the “low” serum 17β-E2 level of 18 pmol/L associated with an increase in growth rate during spontaneous puberty in girls older than 4 years [21]. Eighteen girls had Tanner breast stage 3 but considerably lower levels of serum 17β-E2 than girls during normal spontaneous puberty at Tanner breast stage 3 [22, 23].…”

Section: Discussionmentioning

confidence: 90%

17β-Estradiol and Gonadotropin Levels for the Diagnosis of the Benign Form of Breast Development in Girls Aged up to 4 Years in Real-Life Clinical Practice

Österbrand¹,

Fors²,

Allvin

et al. 2017

Horm Res Paediatr

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Background: Early onset of breast development in a young girl is usually a benign and isolated prepubertal condition, i.e., premature thelarche (PT), but can sometimes be progressive and the first sign of pubertal precocity (PP). Serum 17β-estradiol (17β-E2) level is a possible marker to differentiate between benign and pathological forms of breast development. We defined an upper serum 17β-E2 level for benign, “classic” PT for girls aged 9–48 months. Methods: Serum 17β-E2 was analysed with a highly sensitive extraction radioimmunoassay (RIA). Gonadotropins, Tanner breast stage, growth, other investigations, and clinical outcome were assessed in 125 girls with breast development, in a population-based study in West Sweden. Results: A total of 125 of 128 girls had a benign form of breast development with a mean serum 17β-E2 level of 15.2 pmol/L and a mean + 2 SD of 31 pmol/L, which was regarded as the upper limit for benign PT; 3 girls with PP had 17β-E2 levels above 70 pmol/L. Conclusion: This is the first study to define an upper serum 17β-E2 level associated with benign PT. Girls aged 9–48 months with PT and Tanner breast stage 2 have 17β-E2 levels below 32 pmol/L using extraction RIA. LH below the detection limit (0.1 IU/L) and measurable FSH support benign PT.

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Estradiol and Pubertal Growth in Girls

Cited by 24 publications

References 56 publications

Physiological Estrogen Replacement Therapy for Puberty Induction in Girls: A Clinical Observational Study

Physiological Estrogen Replacement Therapy for Puberty Induction in Girls: A Clinical Observational Study

Pubertal Growth and Serum Testosterone and Estradiol Levels in Boys

17β-Estradiol and Gonadotropin Levels for the Diagnosis of the Benign Form of Breast Development in Girls Aged up to 4 Years in Real-Life Clinical Practice

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