Effects of estrogen therapies on outcomes in Turner syndrome: assessment of induction of puberty and adult estrogen use
Abstract
CONTEXT: Turner syndrome (TS) is often associated with delayed puberty. To induce puberty, estrogen is administered in incremental doses at an age determined by age of presentation. After puberty, various types of maintenance estrogen replacement therapy (ERT) are used. OBJECTIVE: We sought associations between age of induction of puberty and type of ERT on adult health outcomes. DESIGN: Health surveillance data included blood profiles, bone density, and blood pressure. We assessed interactions between these data and age at first estrogen exposure in women with primary amenorrhea. We also assessed these data according to ERT subgroups [combined oral contraceptive pill (OCP), oral estrogen (OE), and transdermal estradiol (TE)] using data from each of 6679 clinic visits, controlling for age, body mass index, and height. SETTING: Adult TS clinic at University College London Hospital. PATIENTS: Of 799 women with TS, 624 had primary amenorrhea and 599 had accurate maintenance ERT data. MAIN OUTCOME MEASURES: Parameters of health surveillance derived from clinical guidelines. RESULTS: Estrogen start age was negatively correlated with adult bone density (spine: r = -0.20 and hip: r = -0.022; P ≤ 0.001). OCP users had higher blood pressure and an adverse lipid profile compared with other ERT subgroups. TE was associated with elevated liver enzymes and hemoglobin A1c compared with OE (P ≤ 0.01). CONCLUSIONS: An earlier age of induction of puberty may be beneficial for adult bone density. Given the high prevalence of hypertension in TS, the use of OCP for ERT should be limited. OE may be a benefit for steatohepatitis.
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There have been few studies comparing the efficacy of oral and transdermal E2 and minimal evidence to guide choice of formulation.
“There have been few studies comparing the efficacy of oral and transdermal (TD) E2 and minimal evidence to guide choice of formulation.”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [284]
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 [284]
Dose and route of E2 do not affect glucose and insulin concentration and tolerance.
“Dose and route of E2 do not affect glucose and insulin concentration and tolerance”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [284]
There is no evidence of liver toxicity from E2 treatment.
“No evidence of liver toxicity”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [284]
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- Authors
- Cameron-Pimblett, A., Davies, M. C., Burt, E., Talaulikar, V. S., La Rosa, C., King, T. F. J., & Conway, G. S.
- Affiliations
- Reproductive Medicine Unit, University College London Hospital, London, United Kingdom
- University College Hospital (GB)
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2019-02-06
- Volume
- 104
- Issue
- 7
- Pages
- 2820-2826
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2912010503
- Cited by
- 40
- References
- 32
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 7 · 2023: 6 · 2022: 10 · 2021: 3 · 2020: 4 · 2019: 3
- FWCI
- 3.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- 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
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Keywords
- Turner syndrome, estrogen replacement therapy, puberty induction, primary amenorrhea, bone mineral density, transdermal estradiol, oral contraceptives, oral estrogen, hypertension, lipid profile, steatohepatitis, liver enzymes, HbA1c
- MeSH terms
- Administration, Cutaneous, Administration, Oral, Adolescent, Adult, Age Factors, Aged, Alanine Transaminase, Alkaline Phosphatase, Blood Pressure, Cholesterol, Contraceptives, Oral, Combined, Estradiol, Estrogens, Female, gamma-Glutamyltransferase, Glycated Hemoglobin, Humans, Middle Aged, Puberty, Delayed, Triglycerides, Turner Syndrome, Bone Density, Estrogen Replacement Therapy, Body Mass Index, Young Adult
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