Conjugated oral versus transdermal estrogen replacement in girls with Turner syndrome: A pilot comparative study

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Abstract

Background: The optimal route of estrogen replacement in Turner syndrome (TS) is unknown. Objective: The objective of the study was to compare conjugated oral vs. transdermal estrogen (TD E2) on bone accrual, uterine growth, pubertal development, IGF-I, and lipids in girls with TS. Methods: Prepubertal GH-treated girls aged 10 yr or older with TS were eligible. Subjects were randomized to conjugated oral estrogen or TDE2 for 1 yr. Assessments included dual-emission x-ray absorptiometry, pelvic ultrasound, Tanner staging, growth velocity, IGF-I, and lipid profile. Results: Twelve girls (14.0 ± 1.7 yr) were enrolled. TD E2 resulted in a significantly greater change in spine bone density at 12 months compared with conjugated oral estrogen (bone mineral content 9.0 ± 0.9 vs. 5.8 ± 0.9 g, P = 0.04; bone mineral density 0.12 ± 0.01 vs. 0.06 ± 0.01 g/cm2, P = 0.004; Z-score 0.7 ± 0.1 vs. 0.3 ± 0.1, P = 0.03). Greater increases in uterine length (4.13 ± 0.39 vs. 1.98 ± 0.39 cm, P = 0.003) and volume (22.2 ± 4.4 vs. 4.0 ± 4.4 ml, P = 0.02) were also found in the TD vs. the oral group at 1 yr. At study end, 66% of subjects in the TD group had a mature uterus vs. 0% in the oral group. No significant differences in other parameters examined were seen. Conclusion: In girls with TS, TD E2 resulted in faster bone accrual at the spine and increased uterine growthcomparedwith conjugated oral estrogen. This pilot study provides preliminary information for optimizing estrogen replacement in this population.

Original languageEnglish
Pages (from-to)2009-2014
Number of pages6
JournalJournal of Clinical Endocrinology and Metabolism
Volume94
Issue number6
DOIs
StatePublished - Jun 2009

Fingerprint

Turner Syndrome
Estrogen Replacement Therapy
Conjugated (USP) Estrogens
Estrogens
Bone Density
Bone
Insulin-Like Growth Factor I
Spine
Lipids
Bone and Bones
Minerals
Growth and Development
Uterus
X-Rays
Growth
Ultrasonics
Population
X rays

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

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title = "Conjugated oral versus transdermal estrogen replacement in girls with Turner syndrome: A pilot comparative study",
abstract = "Background: The optimal route of estrogen replacement in Turner syndrome (TS) is unknown. Objective: The objective of the study was to compare conjugated oral vs. transdermal estrogen (TD E2) on bone accrual, uterine growth, pubertal development, IGF-I, and lipids in girls with TS. Methods: Prepubertal GH-treated girls aged 10 yr or older with TS were eligible. Subjects were randomized to conjugated oral estrogen or TDE2 for 1 yr. Assessments included dual-emission x-ray absorptiometry, pelvic ultrasound, Tanner staging, growth velocity, IGF-I, and lipid profile. Results: Twelve girls (14.0 ± 1.7 yr) were enrolled. TD E2 resulted in a significantly greater change in spine bone density at 12 months compared with conjugated oral estrogen (bone mineral content 9.0 ± 0.9 vs. 5.8 ± 0.9 g, P = 0.04; bone mineral density 0.12 ± 0.01 vs. 0.06 ± 0.01 g/cm2, P = 0.004; Z-score 0.7 ± 0.1 vs. 0.3 ± 0.1, P = 0.03). Greater increases in uterine length (4.13 ± 0.39 vs. 1.98 ± 0.39 cm, P = 0.003) and volume (22.2 ± 4.4 vs. 4.0 ± 4.4 ml, P = 0.02) were also found in the TD vs. the oral group at 1 yr. At study end, 66{\%} of subjects in the TD group had a mature uterus vs. 0{\%} in the oral group. No significant differences in other parameters examined were seen. Conclusion: In girls with TS, TD E2 resulted in faster bone accrual at the spine and increased uterine growthcomparedwith conjugated oral estrogen. This pilot study provides preliminary information for optimizing estrogen replacement in this population.",
author = "Zeina Nabhan and Linda DiMeglio and Rong Qi and Susan Perkins and Erica Eugster",
year = "2009",
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doi = "10.1210/jc.2008-2123",
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T1 - Conjugated oral versus transdermal estrogen replacement in girls with Turner syndrome

T2 - A pilot comparative study

AU - Nabhan, Zeina

AU - DiMeglio, Linda

AU - Qi, Rong

AU - Perkins, Susan

AU - Eugster, Erica

PY - 2009/6

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N2 - Background: The optimal route of estrogen replacement in Turner syndrome (TS) is unknown. Objective: The objective of the study was to compare conjugated oral vs. transdermal estrogen (TD E2) on bone accrual, uterine growth, pubertal development, IGF-I, and lipids in girls with TS. Methods: Prepubertal GH-treated girls aged 10 yr or older with TS were eligible. Subjects were randomized to conjugated oral estrogen or TDE2 for 1 yr. Assessments included dual-emission x-ray absorptiometry, pelvic ultrasound, Tanner staging, growth velocity, IGF-I, and lipid profile. Results: Twelve girls (14.0 ± 1.7 yr) were enrolled. TD E2 resulted in a significantly greater change in spine bone density at 12 months compared with conjugated oral estrogen (bone mineral content 9.0 ± 0.9 vs. 5.8 ± 0.9 g, P = 0.04; bone mineral density 0.12 ± 0.01 vs. 0.06 ± 0.01 g/cm2, P = 0.004; Z-score 0.7 ± 0.1 vs. 0.3 ± 0.1, P = 0.03). Greater increases in uterine length (4.13 ± 0.39 vs. 1.98 ± 0.39 cm, P = 0.003) and volume (22.2 ± 4.4 vs. 4.0 ± 4.4 ml, P = 0.02) were also found in the TD vs. the oral group at 1 yr. At study end, 66% of subjects in the TD group had a mature uterus vs. 0% in the oral group. No significant differences in other parameters examined were seen. Conclusion: In girls with TS, TD E2 resulted in faster bone accrual at the spine and increased uterine growthcomparedwith conjugated oral estrogen. This pilot study provides preliminary information for optimizing estrogen replacement in this population.

AB - Background: The optimal route of estrogen replacement in Turner syndrome (TS) is unknown. Objective: The objective of the study was to compare conjugated oral vs. transdermal estrogen (TD E2) on bone accrual, uterine growth, pubertal development, IGF-I, and lipids in girls with TS. Methods: Prepubertal GH-treated girls aged 10 yr or older with TS were eligible. Subjects were randomized to conjugated oral estrogen or TDE2 for 1 yr. Assessments included dual-emission x-ray absorptiometry, pelvic ultrasound, Tanner staging, growth velocity, IGF-I, and lipid profile. Results: Twelve girls (14.0 ± 1.7 yr) were enrolled. TD E2 resulted in a significantly greater change in spine bone density at 12 months compared with conjugated oral estrogen (bone mineral content 9.0 ± 0.9 vs. 5.8 ± 0.9 g, P = 0.04; bone mineral density 0.12 ± 0.01 vs. 0.06 ± 0.01 g/cm2, P = 0.004; Z-score 0.7 ± 0.1 vs. 0.3 ± 0.1, P = 0.03). Greater increases in uterine length (4.13 ± 0.39 vs. 1.98 ± 0.39 cm, P = 0.003) and volume (22.2 ± 4.4 vs. 4.0 ± 4.4 ml, P = 0.02) were also found in the TD vs. the oral group at 1 yr. At study end, 66% of subjects in the TD group had a mature uterus vs. 0% in the oral group. No significant differences in other parameters examined were seen. Conclusion: In girls with TS, TD E2 resulted in faster bone accrual at the spine and increased uterine growthcomparedwith conjugated oral estrogen. This pilot study provides preliminary information for optimizing estrogen replacement in this population.

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