Efficacy of sex hormone replacement therapy in inducing puberty in primary amenorrhea patients with Turner syndrome

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 498-531-Female Repro Endocrinology & Case Reports
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-503
Izumi Nakashima*, Hideya Sakakibara, Hanako Taniguchi, Aya Tokinaga, Reiko Kitayama, Yuichi Imai, Sachiko Ohori, Taku Tsuburai, Tomoko Nagata, Tomomi Nakamura and Fumiki Hirahara
Yokohama City University School of Medicine, Yokohama, Japan
Introduction: Since primary amenorrhea is a common condition in women with Turner syndrome (TS) because of ovarian dysfunction, sex hormone replacement therapy (HRT) is necessary to induce puberty, resulting in changes such as acquisition of secondary sexual characteristics and increased bone mineral density. However, appropriate protocols have not yet been established. To evaluate the efficacy of HRT in the induction of puberty, a retrospective analysis was conducted in our department.   

Methods: The clinical profiles of 63 TS patients with primary amenorrhea and 8 patients with spontaneous cycles were enrolled with their consent. Uterine length (UL) was measured by ultrasonic examination and bone mineral density (BMD) of the lumbar vertebrae (L2–4) was measured by DEXA. Student’s t-test was used for statistical analysis.

Results: The study group comprised 51 patients who had received HRT and 12 patients who had not. The mean age at first visit was 25.6±6.9 years and that at initiation of HRT was 22.0±5.5 years. The mean height and BMI were 143.7±6.16 cm and 22.0±3.8 kg/m2, respectively. At the time of first visit, the UL of patients receiving HRT (47.0±14.2 mm: n=43) was longer than that of patients without HRT (38.0±11.8 mm: n=8).  However, in both groups the lengths were significantly less than that of the patients with spontaneous cycles, at 62±11.9 mm. The BMD of patients receiving HRT (0.811±0.121 g/cm2: n=51) was significantly higher than that of patients without HRT (0.720±0.122 g/cm2: n=12). However, both were significantly lower than that of patients with spontaneous cycles in which it was 0.979±0.134 g/cm2. After receiving HRT, the UL of all patients significantly increased from 45.6±14mm to 55.7±12mm, and after treatment there was no significant difference between patients treated and those with spontaneous cycles. BMD of the patients without HRT significantly increased from 0.720±0.122 to 0.790±0.108 g/cm2, while there was no significant change in that of the patients with HRT. There was no significant difference in BMD between the patients who had received HRT and those who had not, but in both groups, values were still significantly lower than in those with spontaneous cycles after receiving HRT.

Conclusions: Our results demonstrate that HRT is effective for the acquisition of secondary sexual characteristics and increasing bone mineral density. However, since there is still a significant difference in BMD between the patients with primary amenorrhea and those with spontaneous cycles even after receiving HRT, it is suggested that early initiation of HRT would be more effective.

Nothing to Disclose: IN, HS, HT, AT, RK, YI, SO, TT, TN, TN, FH

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