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 TD E2 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 growth compared with conjugated oral estrogen. This pilot study provides preliminary information for optimizing estrogen replacement in this population.
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Studies differ on whether oral E2 vs TD E2 leads to increased total cholesterol and decreased HDL.
“Studies differ on whether oral E2 vs. TD E2 leads to increased total cholesterol and decreased HDL”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [335]
Earlier initiation of HRT affects BMD with higher BMD/better bone quality/greater trabecular bone score.
“Earlier initiation of HRT does affect BMD with higher BMD/better bone quality/greater trabecular bone score”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [335]
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- Authors
- Nabhan, Z. M., DiMeglio, L. A., Qi, R., Perkins, S. M., & Eugster, E. A.
- Affiliations
- Indiana University Hospital (US)
- Indiana University Indianapolis (US)
- Riley Hospital for Children (US)
- Corresponding author
- Nabhan, Zeina M.
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2009-06-01
- Volume
- 94
- Issue
- 6
- Pages
- 2009-2014
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2120922659
- Cited by
- 119
- References
- 37
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 3 · 2023: 3 · 2022: 9 · 2021: 3 · 2020: 6 · 2019: 15 · 2018: 6 · 2017: 9 · 2016: 5 · 2015: 8 · 2014: 12 · 2013: 9 · 2012: 4
- FWCI
- 4.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic and Clinical Aspects of Sex Determination and Chromosomal Abnormalities
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Estrogen and related hormone effects
- Keywords
- Turner syndrome, estrogen replacement therapy, transdermal estrogen, bone mineral accrual, uterine growth, pubertal development, insulin-like growth factor I, lipid profile
- MeSH terms
- Administration, Cutaneous, Administration, Oral, Adolescent, Body Composition, Bone Development, Child, Estrogens, Conjugated (USP), Female, Humans, Insulin-Like Growth Factor I, Lipids, Pilot Projects, Puberty, Turner Syndrome, Uterus, Bone Density, Estrogen Replacement Therapy, Adolescent Development
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