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      Induction of Puberty in the Hypogonadal Girl – Practices and Attitudes of Pediatric Endocrinologists in Europe

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          Abstract

          The management of children and adolescents with hypogonadism and in particular the induction of puberty in the hypogonadal girl is subject to controversy. Therefore, under the auspices and through organization of the Drugs and Therapeutics Committee of the European Society of Paediatric Endocrinology (ESPE), an interactive voting session and workshop was held at the 39th ESPE Annual Meeting in Brussels to discuss these topics. Common practice in Europe and attitudes of pediatric endocrinologists in Europe were questioned and recorded in the 1.5-hour program. We now report on some of the results of the questionnaires and discussions of that session to further the discussion on and knowledge of current concepts of induction of puberty in the hypogonadal girl in Europe. It became clear from the data accumulated here that the start of treatment, the aims of therapy and the modalities of how to treat the hypogonadal girl vary amongst pediatric endocrinologists in Europe. For example, a chronological age ≧11 years was considered appropriate for the start of estrogen therapy by 40.4% (out of 188 answers), while 47.8 and 7.5% felt that a chronological age ≧13 and ≧15 years respectively was appropriate. In respect to the form and route of estrogen administration, the audience was asked for their common estrogen replacement practice: 31.9% used oral 17β-estradiol treatment, while 10% would prescribe 17β-estradiol transdermal patches. Another 12.2% would recommend conjugated estrogens (e.g. Premarin<sup>®</sup>) orally, 4.8% use oral estradiol valerate and 39.3% ethinylestradiol orally. Only 1.8% out of 229 physicians answering were undecided. In addition, counseling of patients and their families is quite variable and perceptions for example regarding potential pregnancies in affected women are also not uniform. In this report the authors do not want to provide their own personal views but rather reflect current practice in Europe. It is hoped that a more uniform picture will emerge once European and international guidelines on how to treat the girl with hypogonadism will be available and even more discussions amongst doctors from different countries have been led.

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          Most cited references 3

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          Reexamination of the Age Limit for Defining When Puberty Is Precocious in Girls in the United States: Implications for Evaluation and Treatment

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            Estrogen: Consequences and Implications of Human Mutations in Synthesis and Action

             M Grumbach (1999)
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              The Role of Home-Visitation Programs in Improving Health Outcomes for Children and Families

                (1998)
              Traditional pediatric care is often based on the assumption that parents have th basic knowledge and resources to provide a nurturing, safe environment and to provide for the emotional, physical, developmental, and health care needs of their infants and young children. Unfortunately, many families have insufficient knowledge of parenting skills and an inadequate support system of friends, extended family, or professionals to help with these vital tasks. Home-visitation programs offer an effective mechanism to ensure ongoing parental education, social support, and linkage with public and private community services. This statement reviews the history and current research on home-visitation programs and provides recommendations about the pediatrician's role in supporting and using home visitation.
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                Author and article information

                Journal
                HRE
                Horm Res Paediatr
                10.1159/issn.1663-2818
                Hormone Research in Paediatrics
                S. Karger AG
                1663-2818
                1663-2826
                2002
                2002
                29 April 2002
                : 57
                : 1-2
                : 66-71
                Affiliations
                aHospital for Children and Adolescents, University of Leipzig, Germany; bCobbold Labs, Middlesex Hospital, London, UK; cKarolinska Hospital, Karolinska Insitutet, Stockholm, Sweden; dPediatric Endocrinology, Wyler Children’s Hospital, University of Chicago, Ill., USA; ePediatric Department, University of Parma, Italy; fDepartment of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark; gDivision of Endocrinology, Sophia Children’s Hospital, University of Rotterdam, The Netherlands and hDivision of Pediatric and Adolescent Medicine, University of Liège, Belgium
                Article
                57952 Horm Res 2002;57:66–71
                10.1159/000057952
                12006724
                © 2002 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 4, Tables: 1, References: 18, Pages: 6
                Categories
                ESPE Bulletin Board

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