p.4
Role of Oestrogen and Progestogen in Treatment
When is progestogen introduced in treatment?
After a suitable duration of unopposed oestrogen or if breakthrough unscheduled bleeding occurs.
p.2
Normal Pubertal Development in Girls
What is the impact of low-dose versus high-dose oestrogen on bone development?
Low-dose oestrogen increases height velocity, while high-dose oestrogen results in closure of the epiphyseal growth plates.
p.1
Introduction to Sex Steroid Treatment
What is the primary focus of the paper titled 'Sex Steroid Treatment for Pubertal Induction and Replacement in the Adolescent Girl'?
The paper discusses the use of sex steroid treatment for inducing and replacing puberty in adolescent girls.
p.5
Induction of Puberty Regimens and Evidence Base
How should oestrogen be introduced in adolescent girls with delayed puberty?
Using fractions of a transdermal matrix oestradiol patch, aiming for months of unopposed oestrogen administration.
p.5
Role of Oestrogen and Progestogen in Treatment
What delivery method should be considered for hypogonadal girls established on oestrogen replacement?
Regimens using transdermal oestradiol patches.
p.4
Role of Oestrogen and Progestogen in Treatment
What alternative progestogens may have fewer side effects?
Medroxyprogesterone acetate or micronized progesterone.
p.5
Common Conditions Requiring Sex Steroid Replacement
What is the role of combined oral contraceptives in relation to ovarian function?
Limited to those in whom the return of ovarian function is possible and who require contraception.
p.5
Long-term Outcomes of Oestrogen Replacement
What outcomes are researched for long-term users of oestrogen replacement?
Outcomes for endometrial and breast cancer, cardiovascular health, and bone density.
p.2
Definition and Causes of Delayed Puberty
What should be done for girls with complete absence of breast development by age 13?
They should be referred for full evaluation.
p.4
Role of Oestrogen and Progestogen in Treatment
How is progestogen usually administered?
As part of a pre-packed cyclical regimen with oestradiol.
p.5
Induction of Puberty Regimens and Evidence Base
What should be done after breakthrough bleeding occurs during oestrogen treatment?
Cyclical progestins should be introduced.
p.4
Induction of Puberty Regimens and Evidence Base
What is the effect of introducing oestrogen at an earlier age in adolescents requiring growth hormone treatment?
It is now thought to have no adverse effect on final height.
p.3
Induction of Puberty Regimens and Evidence Base
What adverse effect can early administration of progestogen have?
It may impair breast development.
p.2
Normal Pubertal Development in Girls
What are the first signs of oestrogen effects in girls?
Breast budding, which occurs in 50% of girls by age 11.3 years.
p.5
Future Research Directions in Puberty Induction
What further studies are required regarding transdermal oestradiol patches?
To establish the role for this route of delivery with respect to cardiovascular and bone outcomes.
p.4
Common Conditions Requiring Sex Steroid Replacement
What is the role of adipose tissue in bone development for adolescents?
It is a source of oestrone that supports bone development.
p.3
Common Conditions Requiring Sex Steroid Replacement
What condition is associated with the need for sex steroid replacement?
Constitutional delay of puberty.
p.2
Induction of Puberty Regimens and Evidence Base
What factors influence the choice of sex steroids for inducing puberty?
Local tradition, timing of oestrogen initiation, duration of unopposed oestrogen, and potential interference with other treatments.
p.3
Clinical Recommendations for Treatment Initiation
Why is it important for adolescents to engage in the decision-making process regarding dose adjustments?
To ensure they are involved in their treatment up to menarche.
p.4
Induction of Puberty Regimens and Evidence Base
What is the recommended starting age for low dose transdermal oestrogen in adolescents?
About the age of 10 years.
p.4
Common Conditions Requiring Sex Steroid Replacement
What should be considered for adolescents with hypothalamic amenorrhoea caused by eating disorders?
Oestrogen replacement should be introduced as soon as the deficiency is recognized.
p.4
Common Conditions Requiring Sex Steroid Replacement
What is the concern with using combined oral contraceptive pills in young women?
They do not provide optimal oestrogen replacement and should only be used if contraception is required.
p.2
Sex Steroid Treatment for Pubertal Induction and Replacement
What is the primary goal of sex steroid replacement in girls with hypogonadism?
To allow progression through puberty similar to girls with normal gonadal function.
p.3
Induction of Puberty Regimens and Evidence Base
What is the typical age for a girl presenting with delayed puberty to start oestrogen treatment?
At least four years late, typically around the teenage years.
p.2
Induction of Puberty Regimens and Evidence Base
What is the significance of the two years prior to menarche in treatment?
It is equivalent to two years of unopposed oestrogen, crucial for breast development.
p.5
Clinical Recommendations for Treatment Initiation
What is mandatory for girls presenting with primary amenorrhoea before starting oestrogen?
Assessment of potential for growth with involvement of a paediatric endocrinologist.
p.2
Definition and Causes of Delayed Puberty
What defines delayed puberty in girls?
Absence of breast development by age 13 or absence of menarche by age 14.5.
p.3
Induction of Puberty Regimens and Evidence Base
What is the preferred method of administering oestrogen in the UK?
Transdermal matrix patches.
p.3
Induction of Puberty Regimens and Evidence Base
What is a potential consequence of administering exogenous oestrogen too early?
Diminished final height due to earlier closure of epiphyses.
p.2
Common Conditions Requiring Sex Steroid Replacement
What common conditions can result in oestrogen deficiency in adolescents?
Conditions like Turner syndrome and PCOS.
