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Route of estrogen delivery may affect metabolic parameters in Turner syndrome
Fasting glucose, total cholesterol and whole-body bone mineral density may be more improved with transdermal estrogens compared with oral estrogens in girls with Turner syndrome, according to findings published in Endocrine Practice.
However, LDL and HDL cholesterol are more favorably affected by oral estrogens, according to the researchers.
“Although long-term follow-up studies on large numbers of patients with Turner syndrome are lacking, there is some evidence to suggest a beneficial impact of transdermal estrogen as compared to oral estrogen on metabolic and skeletal parameters in Turner syndrome,” Asma Javed, MBBS, of the division of pediatrics and adolescent gynecology, Mayo Clinic, told Endocrine Today.
Javed and colleagues conducted a systematic review and meta-analysis of four studies that included 90 patients with Turner syndrome; 50 received oral estrogens (35 17-beta estradiol; 15 mixed of both oral estrogen forms) and 40 received transdermal estrogens. Follow-up in the studies ranged from 6 to 24 months.
Overall, researchers found no statistically significant differences for fat mass, free fat mass, insulin-like growth factor I, fasting insulin, IGF binding protein 3, triglycerides, estradiol or estrone levels between participants treated with oral vs. transdermal estrogens.
Transdermal estrogens yielded greater increases in whole-body BMD z score, decreases in fasting glucose and total cholesterol compared with oral estrogens.
Oral estrogens yielded greater decreases in LDL cholesterol and increases in HDL cholesterol compared with transdermal estrogens.
“Clinicians often struggle with identifying the ideal dose and delivery route for hormone replacement in Turner syndrome,” Javed told Endocrine Today. “Therefore, the results from this systematic review along with synthesizing information from prospective clinical trials will allow clinicians to have an informed discussion with patients regarding the optimal route of hormone replacement for them.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.