Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Tazim Dowlut-McElroy
Start Date
13-5-2025 11:30 AM
End Date
13-5-2025 1:30 PM
Presentation Type
Poster Presentation
Description
Background
Turner Syndrome (TS) is associated with primary ovarian insufficiency (POI). Most adolescents with TS require hormone replacement therapy (HRT).1 International guidelines recommend transdermal estradiol (TDE) as first-line estrogen replacement therapy.1 Care within a multidisciplinary clinic (MDC) has been associated with higher adherence to screening guidelines for metabolic and auditory disorders in TS.2 It is unknown if adherence to guidelines for postpubertal HRT differ for adolescents with TS managed in a MDC compared to those managed outside of a MDC. Our study aimed to compare 1) postpubertal HRT regimen prescribed, and 2) compliance to HRT and menstrual bleeding patterns for adolescents with TS who did and did not attend a MDC.
Methods
This was a single-site, IRB-approved, retrospective study of post-pubertal TS patients (< 22yo) with POI who had a clinic visit at Children’s Mercy Hospital between 1/1/2021 and 12/31/2024. Demographics, clinic attendance, HRT regimens, and menstrual outcomes were extracted from chart review. Statistical analysis was performed using independent t-tests and Chi-Squared/Fisher’s Exact tests. Statistical significance was defined as p<0.05.
Results
32 participants met criteria. 14 (43.8%) attended the MDC at least once. Those who attended MDC were 1.5 years younger than those who did not (14.9 + 1.7 vs 16.4 + 1.7, p=0.02). 24 (75%) were prescribed HRT by a pediatric endocrinologist. 18 (56.3%) were prescribed TDE, of which 14 (77.7%) were prescribed a dose of >75mcg/day. 13 (40.6%) were prescribed a combined hormonal contraceptive (CHC), with 9 (69.2%) prescribed a dose of >30mcg/day of ethinyl estradiol. Those who attended the MDC were more likely to consult with a pediatric gynecologist (OR 9.0, CI 1.7-47.0, p=0.01). There was no significant difference amongst types or dose of prescribed HRT amongst those who did and did not attend the MDC. TDE use was significantly more common than CHC amongst those evaluated by a pediatric gynecologist (91.7% vs 40%, p=0.01). There was no difference in HRT compliance or menstrual bleeding patterns amongst those who attended the MDC or not.
Conclusion
Adolescents with TS who attended MDC were more likely to be evaluated by a pediatric gynecologist and were subsequently more likely to use TDE. While MDC did not impact the type or dose of HRT prescribed, our study highlights that consultation with a pediatric gynecologist is associated with increased adherence to international HRT guidelines.
Impact of a multidisciplinary clinic on hormone replacement therapy in adolescents with Turner Syndrome
Background
Turner Syndrome (TS) is associated with primary ovarian insufficiency (POI). Most adolescents with TS require hormone replacement therapy (HRT).1 International guidelines recommend transdermal estradiol (TDE) as first-line estrogen replacement therapy.1 Care within a multidisciplinary clinic (MDC) has been associated with higher adherence to screening guidelines for metabolic and auditory disorders in TS.2 It is unknown if adherence to guidelines for postpubertal HRT differ for adolescents with TS managed in a MDC compared to those managed outside of a MDC. Our study aimed to compare 1) postpubertal HRT regimen prescribed, and 2) compliance to HRT and menstrual bleeding patterns for adolescents with TS who did and did not attend a MDC.
Methods
This was a single-site, IRB-approved, retrospective study of post-pubertal TS patients (< 22yo) with POI who had a clinic visit at Children’s Mercy Hospital between 1/1/2021 and 12/31/2024. Demographics, clinic attendance, HRT regimens, and menstrual outcomes were extracted from chart review. Statistical analysis was performed using independent t-tests and Chi-Squared/Fisher’s Exact tests. Statistical significance was defined as p<0.05.
Results
32 participants met criteria. 14 (43.8%) attended the MDC at least once. Those who attended MDC were 1.5 years younger than those who did not (14.9 + 1.7 vs 16.4 + 1.7, p=0.02). 24 (75%) were prescribed HRT by a pediatric endocrinologist. 18 (56.3%) were prescribed TDE, of which 14 (77.7%) were prescribed a dose of >75mcg/day. 13 (40.6%) were prescribed a combined hormonal contraceptive (CHC), with 9 (69.2%) prescribed a dose of >30mcg/day of ethinyl estradiol. Those who attended the MDC were more likely to consult with a pediatric gynecologist (OR 9.0, CI 1.7-47.0, p=0.01). There was no significant difference amongst types or dose of prescribed HRT amongst those who did and did not attend the MDC. TDE use was significantly more common than CHC amongst those evaluated by a pediatric gynecologist (91.7% vs 40%, p=0.01). There was no difference in HRT compliance or menstrual bleeding patterns amongst those who attended the MDC or not.
Conclusion
Adolescents with TS who attended MDC were more likely to be evaluated by a pediatric gynecologist and were subsequently more likely to use TDE. While MDC did not impact the type or dose of HRT prescribed, our study highlights that consultation with a pediatric gynecologist is associated with increased adherence to international HRT guidelines.
