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

Ruszała, Anna; Wójcik, Małgorzata; Zygmunt-Górska, Agata; Januś, Dominika; Wojtyś, Joanna; Starzyk, Jerzy

doi:10.1007/s40618-017-0665-3

Cited by 9 publications

(5 citation statements)

References 28 publications

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“…Analyzing the results of our study, we observed a negative effect of visceral adipose tissue on hand grip strength in the control group, which could not be proven in subjects with TS. Excess body fat, especially visceral fat, is associated with insulin resistance and systemic inflammation, which can impair muscle function [39,40]. In the context of TS, understanding the role of visceral adipose tissue in muscle weakness is crucial, as it can provide insight into strategies to improve muscle strength through weight control and dietary interventions [41].…”

Section: Discussionmentioning

confidence: 99%

The Interplay between Muscular Grip Strength and Bone Mineral Density with Consideration of Metabolic and Endocrine Parameters in Individuals with Turner Syndrome

Krzyścin,

Gruca-Stryjak,

Soszka-Przepiera

et al. 2023

Biomedicines

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Introduction: Patients with Turner syndrome (TS) often face skeletal and muscular challenges, including reduced bone mineral density (BMD) and muscle weakness. This comprehensive study sheds light on the complex interplay between muscle strength, BMD, and metabolic and endocrine parameters in TS and healthy subjects. Methods: A cross-sectional study involving 42 TS patients and 70 healthy women was conducted. All patients had their BMD determined in the L1–L4 lumbar spine section and in the whole skeleton as well as the parameters of body fat mass (BF), and visceral fat mass (VF) were also determined. The maximum gripping force was measured with a hydraulic manual dynamometer. In addition, a number of blood hormonal and metabolic parameters were determined. Results: In the TS group, hand grip strength correlated positively with triglyceride levels but not with BMD. Healthy individuals had a positive link between hand grip strength and BMD, while patients with TS did not show a significant association between the two. A trend suggested that longer recombinant human growth hormone (rhGH) therapy might improve BMD in the L1–L4 region. Multiple linear regression analysis revealed that muscle strength assessment may be a potential exponent of reduced BMD, and also used clinically in young adult women but not in individuals with TS. Conclusions: The relationship between BMD variables and hand grip might differ between the two groups, potentially indicating distinct musculoskeletal characteristics in TS patients. Longer rhGH therapy in TS patients may have a positive effect on BMD in the L1–L4 region. Understanding the intricate relationships between these factors is important for optimizing clinical management strategies and improving the quality of life for TS patients.

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Section: Discussionmentioning

confidence: 99%

The Interplay between Muscular Grip Strength and Bone Mineral Density with Consideration of Metabolic and Endocrine Parameters in Individuals with Turner Syndrome

Krzyścin,

Gruca-Stryjak,

Soszka-Przepiera

et al. 2023

Biomedicines

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“…The current consensus is that if gonadotropins are elevated, treatment should begin at 11-12 years to mimic normal physical and social development without interfering with the effect of growth hormone therapy on final height [16,17]. Although some studies showed the benefits of prepubertal introduction of low-dose estrogen on lipid and metabolic profile and denied its negative impact on final height [18,19], this practice is still under investigation [16]. In this survey, 84.5% would start estrogen for girls aged 11 years and older with TS, with 11-12 years being the most frequently (51.3%) suggested age, while only 5.3% consider it during early/ mid childhood.…”

Section: Discussionmentioning

confidence: 99%

Timing and regimen of puberty induction in children with hypogonadism: a survey on the practice in Arab countries

Hamza

Deeb

Saffar³

et al. 2020

Journal of Pediatric Endocrinology and Metabolism

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ObjectivesThere are some variations in the practice of puberty induction between different regions; however, data from Arab countries are lacking. We aimed to survey the practice of pediatric endocrinologists in Arab countries on the timing and regimen for puberty induction in girls and boys with hypogonadism.MethodsAn online questionnaire was emailed to physicians registered in the Arab Society for Paediatric Endocrinology and Diabetes.ResultsIn total, 106 replies from 17 countries were received. In non Turner syndrome (TS) girls, puberty was induced by 49.4% of participants at 12–13 years and by 32.5% at ≥14 years. Ethinyl estradiol and conjugated estrogen were the most popular preparations used (29.7 and 16.6%, respectively). Of the participants, 60% introduce progesterone either at 2–3 years after starting estrogen or following a significant breakthrough bleeding on estrogen. In girls with TS, 84.2% of participants prescribed estrogen to those aged 11 years and older (51.5% at 11–12 years) and 5.3% prescribed it to those at the prepubertal age. In boys, 57.3% of participants induce at ≥14 years, 80.6% use intramuscular testosterone and 46.5% start with 50 mg/kg/month. Human chorionic gonadotropin is more used in non-Gulf Arab countries (18.2 vs. 2.9%; p 0.036) with a trend of using oral testosterone undecanoate in Gulf states (12.2 vs. 2.0%; p 0.051).ConclusionsWe describe the approach to puberty induction in boys and girls among pediatric endocrinologists in Arab countries. The observed variation in practice would be useful in developing regional consensus guidelines on puberty induction in children with hypogonadism.

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“…In Fig. 4, final height was compared between early (age 10-12 years) and late (from age 12 years) start of oestrogen treatment (EE2 or E2) in a meta-analysis using six studies (108,109,110,111,112,113). Early start of treatment did not result in a clearly lower final height than the late start of treatment (difference −1.0 cm; 95% CI: −4.0 to 1.9 cm).…”

Section: Clinical Question III What Is the Optimal Treatment To Induc...mentioning

confidence: 99%

“…In Fig. 5, BMI was compared between early (age 10-12 years) and late (from age 12 years) start of oestrogen treatment in a meta-analysis using two studies (108,111). The early start of treatment resulted in a lower, though not significantly, BMI than the late start of treatment (difference −0.9 points; 95% CI: −2.7 points to 0.9 points).…”

Section: Clinical Question III What Is the Optimal Treatment To Induc...mentioning

confidence: 99%

Pubertal induction and transition to adult sex hormone replacement in patients with congenital pituitary or gonadal reproductive hormone deficiency: an Endo-ERN clinical practice guideline

Nordenström

Ahmed

Akker

et al. 2022

European Journal of Endocrinology

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An Endo-European Reference Network (ERN) guideline initiative was launched including 16 clinicians experienced in endocrinology, pediatric and adult, and 2 patient representatives. The guideline was endorsed by the European Society for Pediatric Endocrinology, the European Society for Endocrinology and the European Academy of Andrology. The aim was to create practice guidelines for clinical assessment and puberty induction in individuals with congenital pituitary or gonadal hormone deficiency. A systematic literature search was conducted and the evidence graded according to Grading of Recommendations, Assessment, Development and Evaluation system. When evidence was insufficient or lacking, conclusions were based on expert opinion. The guideline includes recommendations for puberty induction with oestrogen or testosterone. Publications on induction of puberty with FSH and hCG in hypogonadotrophic hypogonadism are reviewed. Specific issues in individuals with Klinefelter syndrome or androgen insensitivity syndrome are considered. The expert panel recommend that pubertal induction or sex hormone replacement to sustain puberty should be treated by a multidisciplinary team. Children with a known condition should be followed from the age of 8 years for girls and 9 years for boys. Puberty induction should be individualized but considered at 11 years in girls and 12 years in boys. Psychological aspects of puberty and fertility issues are especially important to address in individuals with a disorder of sex development or congenital pituitary deficiencies. Transition of these young adults highlights the importance of a multidisciplinary approach, to discuss both medical issues and social and psychological issues that arise in the context of these chronic conditions.

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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

Cited by 9 publications

References 28 publications

The Interplay between Muscular Grip Strength and Bone Mineral Density with Consideration of Metabolic and Endocrine Parameters in Individuals with Turner Syndrome

The Interplay between Muscular Grip Strength and Bone Mineral Density with Consideration of Metabolic and Endocrine Parameters in Individuals with Turner Syndrome

Timing and regimen of puberty induction in children with hypogonadism: a survey on the practice in Arab countries

Pubertal induction and transition to adult sex hormone replacement in patients with congenital pituitary or gonadal reproductive hormone deficiency: an Endo-ERN clinical practice guideline

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