title: Puberty induction in Turner syndrome: results of oestrogen treatment on development of secondary sexual characteristics, uterine dimensions and serum hormone levels.
abstract: BACKGROUND
  Besides short stature, gonadal dysgenesis leading to a lack of oestrogen is one of the main characteristics of Turner syndrome (TS). In most TS girls, puberty is induced with exogenous oestrogens.
  
  
  OBJECTIVE
  To describe the pubertal development and uterine dimensions achieved by low-dose 17beta-oestradiol (17beta-E2) orally started at an appropriate age. Additionally, to determine whether serum hormone levels aid evaluation of pubertal progression.
  
  
  METHODS
  In 56 TS girls, we prospectively studied pubertal stage, serum E2, LH, FSH, SHBG and oestrone (E1), starting oestrogen treatment with a low-dose 17beta-E2 (5 microg/kg/day) during GH treatment at mean (SD) age 12.7 (0.7) years. Hormone levels were measured at start, 3 months after start and after increasing 17beta-E2 dosage. Uterine dimensions were measured in 39 TS women at age 19.9 (2.2) years.
  
  
  RESULTS
  Although breast and pubic hair development were similar to that in normal Dutch girls up to Tanner stage B5 and P5, respectively, breast development was 2 years later. Before oestrogen therapy, E2 levels were comparable to those in prepubertal girls. With a 17beta-E2 dose of 5 microg/kg/day, these levels increased significantly, becoming comparable to normal late pubertal or adult concentrations, whereas SHBG levels were unchanged. At the adult 17beta-E2 dose, SHBG had increased significantly. Uterus shape was juvenile in four (10.2%), cylindrical in four and mature-adult shaped in 31 (79.5%) of TS patients.
  
  
  CONCLUSIONS
  During GH treatment in TS girls, normal breast development up to B5 can be mimicked, with just a 2-year delay. In a clinical setting, serum hormone levels provide no additional information for evaluating pubertal progression. After age-appropriate pubertal induction, uterine dimensions in women aged nearly 20 years were subnormal. It remains unclear whether this was related to E2 dosage, timing or duration, or factors related to TS.
authors.affiliation: Department of Paediatrics, Division of Endocrinology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: E M N
authors.initials: EM
authors.lastname: Bannink
authors.forename: C
authors.initials: C
authors.lastname: van Sassen
authors.forename: S
authors.initials: S
authors.lastname: van Buuren
authors.forename: F H
authors.initials: FH
authors.lastname: de Jong
authors.forename: M
authors.initials: M
authors.lastname: Lequin
authors.forename: P G H
authors.initials: PG
authors.lastname: Mulder
authors.forename: S M P F
authors.initials: SM
authors.lastname: de Muinck Keizer-Schrama
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D001940:Breast / Q000187:drug effects / Q000254:growth & development; D002648:Child; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D004958:Estradiol / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D004967:Estrogens / Q000008:administration & dosage / Q000097:blood* / Q000494:pharmacology*; D004970:Estrone / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D011446:Prospective Studies; D011627:Puberty / Q000187:drug effects*; D012727:Sex Characteristics; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D014424:Turner Syndrome / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology*; D014599:Uterus / Q000187:drug effects / Q000473:pathology*; D055815:Young Adult
chemical_list: D004967:Estrogens; D012738:Sex Hormone-Binding Globulin; D004970:Estrone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone