Uterine development during induced puberty in girls with Turner syndrome
Open accessAbstract
Objective Most girls and women with Turner syndrome (TS) require estrogen replacement therapy (ERT) to initiate or maintain pubertal development. Most likely, the most fundamental effect of ERT in hypogonadism is the promotion of uterine growth. The optimal ERT model is still being discussed. The present study aimed to assess uterine size in girls with TS in the prepubertal state during and after the induction of puberty and compare it to a healthy population. Methods The analysis encompassed 40 TS girls. The prepubertal and postpubertal control groups contained 20 healthy girls each. All patients with TS were treated with 17-ß estradiol. Uterine imaging was performed with two-dimensional (2D) transabdominal ultrasound. The uterine volume (UV) and fundocervical antero-posterior ratio (FCR) were calculated in patients with TS before the pubertal induction, after 6-12 months of estrogen replacement therapy (ERT), after ≥ 36 months of ERT or ≥ 12 months after menarche. Results The average age of TS patients at estrogen introduction and at the last control visit, when the uterus was considered mature, was 12.9 years and 16.1 years, respectively. The UV in patients with TS at the beginning of ERT was 1.55 ± 1.22 cm3 and was not significantly different from the UV in the prepubertal controls. The mature UV in patients with TS was 31.04 ± 11.78 cm3 and was significantly smaller than the UV of the postpubertal controls (45.68 ± 12.51 cm3, p<0.001). The FCR in girls with TS did not differ significantly from that in the prepubertal and postpubertal control groups, respectively. No prognostic factors could be established for the final UV. By the last control visit, thelarche had advanced in most patients to Tanner 4 and 5 (37.5% and 40%, respectively). Conclusions Before the onset of ERT, patients with TS have a uterus similar in size to that in prepubertal healthy girls. Pubertal induction in patients with TS causes a significant increase in the UV that is detectable after 6-12 months of ERT. The mature uterus is smaller in patients with TS than in the age-matched healthy population.
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The results of pelvic ultrasound in girls with Turner syndrome have not yet proven useful as a marker of spontaneous puberty.
“The results of pelvic ultrasound in girls with TS have not yet proven useful as a marker of spontaneous puberty.”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [277]
Both ultrasound ovarian visualization and uterine volume in comparison to prepubertal controls did not help predict spontaneous puberty.
“Both ultrasound ovarian visualization267 and uterine volume in comparison to prepubertal controls277 did not help predict spontaneous puberty.”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [277]
Uterine growth observed after the first 6-12 months of estrogen therapy induction suggested that uterine volume measurement may be a useful monitoring marker for hormone replacement therapy efficacy.
“Uterine growth observed after the first 6-12 months of estrogen therapy induction suggested that uterine volume measurement may be a useful monitoring marker for HRT efficacy.”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [277]
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Clinical practice guidelines for the care of girls and women with Turner syndrome.
Gravholt, C. H., Andersen, N. H., Christin-Maitre, S., Davis, S. M., Duijnhouwer, A., Gawlik, A., Maciel-Guerra, A. T., Gutmark-Little, I., Fleischer, K., Hong, D., et al. (2024) · European Journal of Endocrinology · doi:10.1093/ejendo/lvae050 · Cited by 224 · see citing works
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- Authors
- Obara-Moszynska, M., Dzialach, L., Rabska-Pietrzak, B., Niedziela, M., & Kapczuk, K.
- Affiliations
- Poznan University of Medical Sciences (PL)
- Venue
- Frontiers in Endocrinology
- Publisher
- Frontiers Media SA
- Published
- 2021-07-06
- Volume
- 12
- Pages
- 707031-707031
- ISSN
- 1664-2392 (ISSN-L)
- PMC
- PMC8290974
- OpenAlex
- W3177896963
- Cited by
- 14
- References
- 27
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 4 · 2023: 5 · 2022: 1 · 2021: 1
- FWCI
- 1.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Endocrinology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu
- 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 › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Keywords
- Turner syndrome, uterine development, estrogen replacement therapy, puberty induction, uterine volume, estradiol, hypogonadism, prepubertal girls, menarche
- MeSH terms
- Child, Child, Preschool, Female, Follow-Up Studies, Humans, Prognosis, Puberty, Turner Syndrome, Uterus, Estrogen Replacement Therapy, Case-Control Studies
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