Current Recommended Estrogen Dosing for Pubertal Induction in Turner Syndrome Results in Normal Uterine Growth

Context: Most individuals with Turner syndrome (TS) require estrogen for pubertal induction. Current estrogen dosing guidelines are based on expert consensus opinion.Objective: Evaluate if current international guidelines for estrogen dosing during pubertal induction of individuals with TS result in normal uterine growth. We hypothesized that uterine size in individuals with TS who reached adult estrogen dosing is smaller than in mature females without TS.Design: Cross-sectional study.Setting: Patients with TS at the Cincinnati Center for Pediatric and Adult Turner Syndrome Care.Participants: 29 individuals (age, 15-26 years) with primary ovarian insufficiency who reached adult estrogen dosing (100 mcg transdermal or 2 mg oral 17 beta-estradiol). Comparison of uterine measurements with a published sample of 292 age-appropriate (age, 15-20 years) controls without TS.Interventions: none.Main outcome measures: Uterine length, volume, and fundal-cervical ratio (FCR) were measured. Clinical information (karyotype, Tanner staging for breast development, laboratory data) was extracted from an existing institutional patient registry.Results: There was no evidence of compromise of the uterine size/configuration in the TS cohort compared with the controls; in fact, uterine length- mean 7.7 cm (+/-1.3) vs. 7.2 cm (+/-1.0) (p = 0.03) and volume- mean 60.6 cm3 (+/-26.6) vs. 50.5 cm3 (+/-20.5) (p = 0.02), were both larger in TS individuals.Conclusion: Current international guidelines for hormone replacement using 17 beta-estradiol in TS individuals appear adequate to allow for normal uterine growth by the end of pubertal induction.