Use of Percutaneous Estrogen Gel for Induction of Puberty in Girls With Turner Syndrome

Piippo, Kl. S.; Lenko, Hanna Liisa; Kainulainen, Petri; Sipilä, Ilkka

doi:10.1097/01.ogx.0000151670.23897.1e

Cited by 15 publications

(18 citation statements)

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“…In general, induction of puberty in TS has been delayed for several years to allow girls with TS to attain a higher stature [23]. Besides the psychosocial implications of late feminization, this practice may result in inadequate peak bone mass [24, 25], poor uterine development [26, 27] and an increased risk for CV disease [28,29,30]. Recent data suggest that low dose estrogen given by a percutaneous route may enhance growth and final adult stature [31, 32].…”

Section: Discussionmentioning

confidence: 99%

Gonadotropin Secretion in Girls with Turner Syndrome Measured by an Ultrasensitive Immunochemiluminometric Assay

et al. 2006

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Background/Aim: Gonadotropin levels measured by radioimmunoassays are high in girls with Turner syndrome (TS), but overlap significantly with those of normal girls. We hypothesized that gonadotropin levels would be above the normal range in TS when measured by ultrasensitive assays. Methods: Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were measured in 68 TS, and 133 control girls using ultrasensitive immunochemiluminometric assays (ICMA). Results: FSH levels in TS and normal girls were highest in early childhood (56.0 ± 39.7 and 2.3 ± 1.8 IU/l, respectively), declined at 6–10 years of age (11.3 ± 13.1 and 1.8 ± 0.9 IU/l, respectively), and then increased again (104.4 ± 68.9 and 4.9 ± 2.4 IU/l, respectively). FSH was in the normal range on 11 of 27 occasions in TS girls with ages 5–10 years, and on 3 of 44 occasions in >10 years. Although average LH values were higher than those of controls, they often overlapped the normal range. Conclusion: A significant number of TS girls have normal gonadotropins by ICMA. Spontaneous gonadotropin levels are not an adequate screening test for the diagnosis of TS but may prove useful for predicting the gonadal function and determining the appropriate timing of estrogen replacement therapy.

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Section: Discussionmentioning

confidence: 99%

Gonadotropin Secretion in Girls with Turner Syndrome Measured by an Ultrasensitive Immunochemiluminometric Assay

et al. 2006

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“…Similarly, patients with hypopituitarism or hypogonadotropic hypogonadism treated with a standard ethinyl estradiol regimen for induction of puberty were also found to have significantly smaller uterus length and uterus cross-sectional area in comparison to controls (10). In contrast, treatment with increasing doses of estradiol gel resulted in normal uterine development in all patients (11). Consideration should also be given to the dose of estradiol, as a positive correlation has been found between postmenarcheal estrogen dose and uterine length (12).…”

Section: Puberty and Adolescencementioning

confidence: 99%

Hypogonadotropic hypogonadism in women: treatment options

Greenman¹

2013

REM

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SummaryTreatment of female hypogonadotropic hypogonadism is geared to mimic normal physiology, allowing for age appropriate development, while preventing complications secondary to sex hormone deprivation. In this paper we review data concerning efficacy and safety of sex hormone replacement therapy at the various stages of female reproduction, taking into account safety profiles of different types of estrogen and progesterone formulations, and their interactions with other components of the pituitary substitutive therapy.

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“…The matrix-like transdermal patches or a gel can be used to minimize oestrogen dose. 8,9 The author tends to use ethinyloestradiol in the first instance but an equivalent low dose of 17b-oestradiol would be appropriate. Patches (25 lg) can be cut into smaller sizes to allow low-dose oestrogen exposure and can certainly allow development through to Breast Stage 3 development.…”

Section: Process Of Pubertal Inductionmentioning

confidence: 99%

“…8 Oestragel data are available for the whole of pubertal induction using doses chosen on the experiences of oestrogen replacement therapy in adults and the bioequivalence of oral oestrogens, transdermal patches or oestradiol gel. 9 The induction programme for ethinyloestradiol and oestragel are depicted in Table 1. It is important to realize that these doses are only a guide to what might be expected 'on average' and individual tailoring of dose and timing will be required.…”

Section: Process Of Pubertal Inductionmentioning

confidence: 99%

How do you initiate oestrogen therapy in a girl who has not undergone puberty?

Hindmarsh

2009

Clinical Endocrinology

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SummaryThe physiology of puberty needs to be taken into consideration in the induction of puberty. Puberty is a relatively slow process and replacement therapy should mimic this. Long-term maintenance requires careful monitoring and long-term assessment of risk-benefit. This has not been appreciably defined in the adolescent population. Options for fertility need careful consideration and may depend on the adequacy of pubertal induction in terms of uterine development. A number of regimens are available for pubertal induction but the lack of comparisons makes it difficult to advocate for a particular regimen. There remain a number of areas of uncertainty, and future studies need to consider these issues and whether there are cardiovascular risk factor advantages to certain preparations. The long-term risks of breast and gynaecological malignancy remain uncertain. Long-term cohort studies are required to address these issues.

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Use of Percutaneous Estrogen Gel for Induction of Puberty in Girls With Turner Syndrome

Cited by 15 publications

References 0 publications

Gonadotropin Secretion in Girls with Turner Syndrome Measured by an Ultrasensitive Immunochemiluminometric Assay

Gonadotropin Secretion in Girls with Turner Syndrome Measured by an Ultrasensitive Immunochemiluminometric Assay

Hypogonadotropic hypogonadism in women: treatment options

How do you initiate oestrogen therapy in a girl who has not undergone puberty?

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