+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Physiological estrogen replacement therapy for puberty induction in girls: a clinical observational study

Physiological estrogen replacement therapy for puberty induction in girls: a clinical observational study

Hormone Research in Paediatrics 81(4): 239-244

The goal of estrogen replacement therapy (ERT) in girls with hypogonadism is to achieve the endocrine milieu similar to natural puberty, where transdermal administration is the most physiological route. The aim of the study was to evaluate guidelines for the induction of puberty with transdermal estradiol (E2) patches in a large outpatient setting. In a retrospective study, serum E2 levels from 18 clinics were analyzed at the Göteborg Pediatric Growth Research Center laboratory, as part of the initiation of ERT in girls with hypogonadism. Exclusion criteria were pubertas tarda and pubertal arrest. Eighty-eight observations (50 with Turner syndrome, TS) were included. Serum E2 levels were determined by extraction + radioimmunoassay (detection limit 4 pmol/l) and analyzed in relation to the dose of Evorel(®) (25 µg/24 h, containing 1.60 mg estradiol hemihydrate; Janssen-Cilag Pharmaceutica N.V., Beerse, Belgium). There was a linear relationship between serum E2 and the weight-based dose, with r = 0.56, p < 0.0001 for all observations and r = 0.59, p < 0.0001 for the TS study group. Linear regression analysis for doses of 0.05-0.07 µg/kg resulted in serum levels of 17-23 pmol/l (TS 17-24 pmol/l) and doses of 0.08-0.12 µg/kg in 26-39 pmol/l (TS 27-39 pmol/l). For the initiation of ERT with nocturnally administered E2 patches, we recommend reduced starting doses of 0.05-0.07 µg/kg, with the goal of mimicking E2 levels during gonadarche. In older girls, when breast development is of high priority, the starting dose can still be 0.08-0.12 µg/kg.

(PDF emailed within 0-6 h: $19.90)

Accession: 055001811

Download citation: RISBibTeXText

PMID: 24503929

DOI: 10.1159/000356922

Related references

Prepubertal ultra-low-dose estrogen therapy is associated with healthier lipid profile than conventional estrogen replacement for pubertal induction in adolescent girls with Turner syndrome: preliminary results. Journal of Endocrinological Investigation 40(8): 875-879, 2017

Late-Onset Puberty Induction by Transdermal Estrogen in Turner Syndrome Girls-A Longitudinal Study. Frontiers in Endocrinology 9: 23, 2018

Transdermal estrogen for the induction of puberty in girls. Hormone Research 31(SUPPL 1): 60, 1989

Induction of puberty in girls with transdermal estrogen. Hormone Research (Basel) 50(SUPPL 3): 110, Sept, 1998

The heart and estrogen/progestin replacement study revisited: hormone replacement therapy produced net harm, consistent with the observational data. Archives of Internal Medicine 160(19): 2897-2900, 2000

Use of Percutaneous Estrogen Gel for Induction of Puberty in Girls With Turner Syndrome. Obstetric and Gynecologic Survey 60(2): 102-103, 2005

Use of percutaneous estrogen gel for induction of puberty in girls with Turner syndrome. Journal of Clinical Endocrinology and Metabolism 89(7): 3241-3247, 2004

Estrogen mini-dose replacement during GnRH agonist therapy in central precocious puberty: a pilot study. Journal of Clinical Endocrinology and Metabolism 87(2): 687-690, 2002

A physiological mode of puberty induction in hypogonadal girls by low dose transdermal 17 beta estradiol. European Journal of Pediatrics 150(2): 86-91, 1990

Evaluation of the climacteric symptomatology modifications and clinical-instrumental parameters in women in physiological menopause treated with hormone replacement therapy with nomegestrol acetate and in surgical menopause treated with estrogen replacement therapy. Part I. Minerva Ginecologica 59(3): 205-214, 2007

Early puberty in internationally adopted girls: hormonal and clinical markers of puberty in 276 girls examined biannually over two years. Hormone Research 72(4): 236-246, 2009

Treatment of constitutionally tall girls with physiological estrogen doses in the prepuberty period. An alternative to high-dose estrogen therapy. Monatsschrift Kinderheilkunde 133(1): 32-37, 1985

Effects of hormone replacement therapy on clinical fractures and height loss: The heart and estrogen/progestin replacement study (HERS). American Journal of Medicine 110(6): 442-450, 2001

Observational study pelvic ultrasound a useful tool in the diagnosis and differentiation of precocious puberty in Chinese girls. Medicine 97(10): E0092, 2018

Metformin therapy during puberty delays menarche, prolongs pubertal growth, and augments adult height: a randomized study in low-birth-weight girls with early-normal onset of puberty. Journal of Clinical Endocrinology and Metabolism 91(6): 2068-2073, 2006