Endocrine Abstracts

JOINT3801

Background: Effective and timely induction of puberty is crucial to ensure optimal physical development, psychosocial well-being, and long-term health outcomes in patients with primary ovarian insufficiency(POI). Turner Syndrome (TS) and chemo or radio-induced damage are the main causes of POI in adolescents. The aim of this study is to evaluate and compare the approaches and outcomes of puberty induction in a cohort of patients affected with POI, secondary to TS or who had undergone hematopoietic stem cell transplantation (HSCT) for oncological or hematological conditions.

Methods: Medical records of patients with POI who received hormonal replacement therapy (HRT) between 2012 and 2021 were retrospectively reviewed. Auxological data and estrogen replacement schedules were recorded from baseline(T0) until the initiation of progestin treatment. Data were collected at intervals of 6(T1), 12(T2), 18(T3), 24(T4) and 36 months(T5). Information on bone age, bone mineral density (BMD) and pelvic ultrasonography findings were gathered.

Results: 53 patients (29 TS and 24 HSCT) were included. No significant differences in auxological parameters were observed between the groups, except for stature. The mean duration of puberty induction was similar in both groups (2.68±0.98years in TS vs. 2.53±1.03years in HSCT), with a shorter duration of HRT in patients who were already at a pubertal stage beyond S1 at T0 (2.20±1.1 vs. 2.80±0.90years, P= 0.04). All patients received transdermal HRT, except for 8 patients with TS who received oral therapy. Across the entire cohort, a positive correlation was observed between the progression of sexual characteristics and the estrogen dose (r = 0.515), which remained significant when analyzing the two groups separately. Growth velocity(GV) mimicked a physiological pubertal spurt in all patients. However, from 18 months onward, TS patients exhibited a more pronounced decline in GV compared to HSCT patients (3.9±1.8 vs 4.7±1.9 cm). At T1, GV showed a weak negative correlation with estrogen dose (r:-0.205), which was more evident in the TS group (r:-0.333). By T2, this association became positive (r:0.293; stronger in TS r:0.388). At other timepoints, no significant associations were observed. Age and estrogen dose at T0 were negatively correlated with final BMD (r=−0.019), but they were positively associated with the magnitude of BMD’s improvement during therapy (r = 0.333).

Conclusions: Our results confirm the importance of starting treatment at a physiological age of puberty, independently of POI origin. Comparable outcomes were observed in the two groups in terms of evolution of puberty, growth velocity, at least in the first year, and bone density.