ESPE Abstracts

Objective: The majority of individuals with Turner syndrome (TS) experience Primary Ovarian Insufficiency requiring hormone replacement therapy (HRT). As the international consensus guidelines are unclear on the optimal formulation and dosing for HRT after pubertal induction in adolescents and young adults (AYA) with TS, our aim was to assess the current HRT practice patterns of endocrinologists and gynecologists.

Methods: An IRB approved survey was disseminated via REDCap to the email listserv members of the North American Society for Pediatric and Adolescent Gynecology and the Pediatric Endocrine Society in 2021.

Results: The 155 respondents who completed the entire survey included 76% (118) pediatric endocrinologists, 16% (24) pediatric gynecologists, 2% (3) obstetrician/gynecologists, and 3% (4) adolescent medicine specialists. More than half (91, 59%) reported being in practice for more than 10 years and practicing in an academic center (99, 64%). The majority (81%, 126) saw an average of 5 or less patients with TS every 3 months. Of the 60% (93) who preferred transdermal estradiol (TDE), only 54% (50) favored a 100μg/day formulation. The remainder preferred lower doses citing “whatever is effective” and “depends on clinical response and blood levels” as determining factors. The majority (81%, 78) preferred oral progesterone. None of the 7% (11) who favored a levonorgestrel-releasing IUD were endocrinologists. Of the 35% (54) who preferred combination oral contraceptive pills (OCP), 46% (25) favored a dose of 30 or 35μg ethinyl estradiol with the remainder preferring lower doses. Factors significantly associated with preferred HRT included specialty (P=0.02) and number of patients per 3 months (P=0.02). Gynecologists were 4 times less likely than endocrinologists to prefer OCP (OR 0.25; 95%CI 0.08, 0.78) and 4 times more likely to favor TDE dose of 100μg/day as compared to lower doses (OR 3.9; 95%CI 1.2,13.3). Attending physicians with 5 or less patients per 3 months were 4.5 times more likely than those with more patients to favor OCPs (OR 4.5; 95%CI 1.2,16.6). Although 87% (135) reported confidence in prescribing HRT to AYA after pubertal induction, only half (51%, 79) were aware of published guidelines and most (88%, 136) would prefer additional guidelines.

Conclusions: Although most endocrinologists and gynecologists report confidence in prescribing HRT to AYA with TS after pubertal induction, there are clear differences in provider preference based on specialty and number of patients. Additional studies on comparative effectiveness of the HRT regimens and evidence-based guidelines are necessary for AYA with TS.