ESPE Abstracts

Introduction: Characteristics of the Turner syndrome (TS) include congenital gonadal dysgenesis resulting in disturbed sexual maturation. Only 20 % of patients with TS menstruate spontaneously. In most cases pharmacological puberty induction is required to maintain female secondary sex characteristics and menarche. Preferred age of start of estrogen replacement is between 11 and 12 years with gradual increase of dose during 2–3 years.

Aim: The aim of the study is to obtain information about the process of puberty induction among patients with TS, their breast satisfaction and side effects of the therapy.

Material and Methods: In the period from August 2020 to April 2022, adult women with ZT and parents of patients with TS were contacted via the messenger application and encouraged to take part in a 15-question anonymous survey regarding the use of estrogen-progesterone replacement therapy. Participation in the survey was voluntary and free of charge.

Results: 108 participants answered the questions. 23 (21.3 %) of respondents had estrogen therapy started at the age between 10 and 12 years, 26 (24 %) between 12 and 14 years, and 27 (25%) between 16 and 18 years. The remaining group consisted of patients who did not start puberty induction yet or matured spontaneously. In the group of patients under 18 years old– 69% started replacement therapy between 10 and 12 years of age. Oral natural estradiol was chosen in 38.9% of cases, transdermal estradiol in patch in 37% of cases and oral ethinyl estradiol in 27.8% of cases. The pubertal induction took less than 1 year in 30.1% of cases, in 25.4% it took between 1 and 2 years, in 21.8 % of cases it took 2-3 years. 59.2% of respondents answered positively when asked about satisfaction with breast development, however the answer “Yes” was less frequent when the puberty induction was made with transdermal estradiol (52.5%) than with natural oral estradiol (71.4%) or ethinyl estradiol (66.7%). What also can be observed, the later the therapy was started, the less satisfaction with breast development was. The most frequently noted problems during puberty induction were: irregular menstrual bleeding (13%), weight gain (8.3%) and local side effects after use of transdermal preparation (8.3%), 40.7% of participants did not report any side effect of hormonal therapy.

Conclusion: Time and way of puberty induction should be carefully considered to bring the satisfying effect and reduced complications.