A 3-year prospective study to assess uterine growth in girls with Turner's syndrome by pelvic ultrasound.
OBJECTIVE
Adult women with Turner's syndrome who have used the donor ovum IVF programme are reported to have reduced pregnancy outcome with an increased risk for first trimester spontaneous abortion. This is considered to be related to a small uterine size and reduced endometrial thickness. This study examines whether adequate oestrogen replacement during the early adolescent years will result in normal adult uterine dimensions, with consequent reduction in these pregnancy risks.


METHODS
A prospective evaluation of uterine dimensions by pelvic ultrasound examination over 3 years, in a group of 18 girls commencing pubertal induction with oestrogen or entering puberty spontaneously.


METHODS
Girls with Turner's syndrome attending the outpatient clinc at the Royal Children's Hospital and due to start oestrogen treatment were invited to participate in the study.


METHODS
Data were collected for clinical parameters of age, pubertal staging, menarche, oestrogen dose and karyotype. Ultrasonographic measurements of uterine length, sagittal and transverse width, endometrial cavity and identification of ovaries were also included.


RESULTS
The mean age at commencement of the study was 14.6 years, mean age at final evaluation was 17.1 years. Karyotype was 45XO in 6/18, mosaic in 12/18. Spontaneous pubertal onset occurred in 5/18. One of these later required the addition of oestrogen treatment. Pubertal induction with oestrogen was used in 13/18 girls. A total of 15/18 girls have either achieved spontaneous menarche or are using adult doses of oestrogen and progestogen with regular withdrawal bleeds. All 18 girls have achieved a uterine length of 5.8-8.6 cm (mean 7.04 cm) within the normal adult range (5-8 cm). Mean uterine volume was 30.23 cm3.


CONCLUSIONS
The study suggests that adequate oestrogen replacement in early to mid adolescence mimicking spontaneous timing of puberty results in normal uterine growth and adult uterine dimensions. Further follow-up of uterine growth in these girls is warranted.
McDonnell
Ciara M
CM
Departments of Endocrinology and Diabetes, Medical Imaging and Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia.
Coleman
Lee
L
Zacharin
Margaret R
MR
D000293:Adolescent; D000328:Adult; D002648:Child; D015914:Estrogen Replacement Therapy; D005260:Female; D013006:Growth Hormone / Q000627:therapeutic use; D006801:Humans; D010053:Ovary / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011627:Puberty; D016896:Treatment Outcome; D014424:Turner Syndrome / Q000000981:diagnostic imaging* / Q000235:genetics; D014463:Ultrasonography; D014599:Uterus / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000254:growth & development
D013006:Growth Hormone