Department of Paediatric Endocrinology and Rheumatology, Institute of Pediatrics, Poznan University of Medical Sciences, Poznan, Poland.
Student Scientific Society of Paediatric Endocrinology, Poznan University of Medical Sciences, Poznan, Poland.
Front Endocrinol (Lausanne). 2021 Jul 6;12:707031. doi: 10.3389/fendo.2021.707031. eCollection 2021.
Most girls and women with Turner syndrome (TS) require estrogen replacement therapy (ERT) to initiate or maintain pubertal development. Most likely, the most fundamental effect of ERT in hypogonadism is the promotion of uterine growth. The optimal ERT model is still being discussed. The present study aimed to assess uterine size in girls with TS in the prepubertal state during and after the induction of puberty and compare it to a healthy population.
The analysis encompassed 40 TS girls. The prepubertal and postpubertal control groups contained 20 healthy girls each. All patients with TS were treated with 17-ß estradiol. Uterine imaging was performed with two-dimensional (2D) transabdominal ultrasound. The uterine volume (UV) and fundocervical antero-posterior ratio (FCR) were calculated in patients with TS before the pubertal induction, after 6-12 months of estrogen replacement therapy (ERT), after ≥ 36 months of ERT or ≥ 12 months after menarche.
The average age of TS patients at estrogen introduction and at the last control visit, when the uterus was considered mature, was 12.9 years and 16.1 years, respectively. The UV in patients with TS at the beginning of ERT was 1.55 ± 1.22 cm and was not significantly different from the UV in the prepubertal controls. The mature UV in patients with TS was 31.04 ± 11.78 cm and was significantly smaller than the UV of the postpubertal controls (45.68 ± 12.51 cm, p<0.001). The FCR in girls with TS did not differ significantly from that in the prepubertal and postpubertal control groups, respectively. No prognostic factors could be established for the final UV. By the last control visit, thelarche had advanced in most patients to Tanner 4 and 5 (37.5% and 40%, respectively).
Before the onset of ERT, patients with TS have a uterus similar in size to that in prepubertal healthy girls. Pubertal induction in patients with TS causes a significant increase in the UV that is detectable after 6-12 months of ERT. The mature uterus is smaller in patients with TS than in the age-matched healthy population.
大多数特纳综合征（TS）女孩和女性需要雌激素替代疗法（ERT）来启动或维持青春期发育。ERT 在性腺功能减退症中最基本的作用很可能是促进子宫生长。最佳的 ERT 模型仍在讨论中。本研究旨在评估青春期前 TS 女孩在青春期诱导期间和之后的子宫大小，并将其与健康人群进行比较。
分析包括 40 名 TS 女孩。每个青春期前和青春期后对照组均包含 20 名健康女孩。所有 TS 患者均接受 17-β雌二醇治疗。采用二维（2D）经腹超声对子宫进行成像。在青春期诱导前、雌激素替代治疗（ERT） 6-12 个月后、ERT 治疗≥36 个月或月经初潮后≥12 个月时，计算 TS 患者的子宫体积（UV）和宫底宫颈前后径比（FCR）。
ERT 引入时和最后一次控制就诊时 TS 患者的平均年龄分别为 12.9 岁和 16.1 岁。ERT 开始时，TS 患者的 UV 为 1.55±1.22cm，与青春期前对照组的 UV 无显著差异。TS 患者的成熟 UV 为 31.04±11.78cm，明显小于青春期后对照组的 UV（45.68±12.51cm，p<0.001）。TS 女孩的 FCR 与青春期前和青春期后对照组均无显著差异。未建立最终 UV 的预后因素。在最后一次控制就诊时，大多数患者的初潮进展到 Tanner 4 和 5（分别为 37.5%和 40%）。
ERT 开始前，TS 患者的子宫大小与青春期前健康女孩相似。TS 患者青春期诱导会导致 UV 显著增加，在 ERT 治疗 6-12 个月后即可检测到。TS 患者的成熟子宫小于年龄匹配的健康人群。
