Endocrine Abstracts

The British Society for Paediatric Endocrine and Diabetes (BSPED) published guidance in 2016 on optimal Hormonal Replacement Therapy (HRT) for pubertal induction in Turner Syndrome (TS). Transdermal preparations of oestrogen are the most appropriate method of oestrogen delivery in TS, as it avoids first pass metabolism of the liver, and thereby does not exert a meaningful effect on blood pressure.

Objective: To assess change in prescribing practice in accordance with BSPED guidance.

Methods: Electronic records and case note review of all girls attending a dedicated paediatric TS clinic, Royal Hospital for Children Glasgow. Data collected included date of commencing hormone replacement therapy (HRT) and oestrogen preparation used (oral ethinyloestradiol, oral 17b-oestradiol or transdermal oestrogen). Girls were consulted to determine what influenced their choice of oestrogen preparation and gauge their understanding of the aims of hormone replacement.

Results: 29 girls were included who had commenced oestrogen therapy of which 24 were pre-guidance and 5 were post-guidance. 24 (100%) girls were commenced on ethinyloestradiol pre-guidance and 1 (20%) girl post-guidance (with 2 commenced on 17b-oestradiol and 2 girls commenced on transdermal oestrogen). The most common reasons offered for reticence to a transdermal preparation was fear that the patch would be visible, and doubts around how to accurately cut the patch to ensure adequate dosing.

Discussion: In response we liaised with Turner Syndrome Support Society (TSSS) to develop a video on how to prepare and apply transdermal oestrogen. This resource is available online, free of charge, for patients and their families. We have also produced a visual aid for use in demonstration/discussion with girls and their families on the available preparations of oestrogen and progesterone used in pubertal induction. The video was launched at two patient engagement zoom events hosted by TSSS to discuss the process of pubertal induction and the relative merits of the various oestrogen preparations.