June 13, 2013
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Estrogen delivery methods examined in girls with Turner’s syndrome

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Researchers observed little differences in the metabolic long-term effects of oral vs. transdermal 17 beta-estradiol hormone therapy in girls with Turner’s syndrome, according to new data. However, transdermal estradiol appeared to effect a more physiological estrogen milieu.

Perspective from Elizabeth Fudge, MD

“In the postmenopausal literature a number of studies have previously suggested that estrogen given orally has deleterious effects on body composition and lipid oxidation as compared to transdermal and that it could serve as a functional [growth hormone] antagonist by suppressing [insulin-like growth factor I]. However, this has not been consistently confirmed,” the researchers wrote.

They randomly assigned 40 girls (mean age, 16.7 years) to oral or transdermal 17 beta-estradiol (Estrace, Bristol-Myers Squibb) replacement therapy (20 per group) to assess the metabolic effects of the different delivery methods.

According to data, the researchers administered titrated estradiol concentrations to normal range in both groups (mean oral dose, 2 mg; mean transdermal dose, 0.1 mg). The researchers found that fat free mass and percent fat mass, bone mineral density accrual, lipid oxidation and resting energy expenditure rates were similar between groups after 6 and 12 months of therapy.

IGF-1 concentrations appeared to be lower with oral 17 beta estradiol. However, the suppression of gonadotropins demonstrated no significant changes to lipids, glucose, osteocalcin or high-sensitivity C-reactive protein (hsCRP) between groups. Researchers wrote that estrone (E1), estrone sulfate (E1S), sex hormone-binding globulin (SHBG), and bioestrogen concentrations were significantly greater among patients who received the oral formulation.

These findings indicate girls with Turner’s syndrome displayed no differences in metabolic effects of oral vs. transdermal 17 beta-estradiol.

Disclosure: Santen reports consultancy related to estrogen for Pfizer, Novo Nordisk and TEVA Women’s Health. Mauras reports drug supply agreements and grant support from Pfizer. All other researchers report no relevant financial disclosures.