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Aversa T, Corica D, Pepe G, Pajno GB, Valenzise M, Messina MF, Wasniewska M. Pubertal induction in girls with Turner Syndrome. Minerva Endocrinol (Torino) 2021; 46:469-480. [PMID: 33435643 DOI: 10.23736/s2724-6507.20.03285-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Turner Syndrome (TS) is the most common female sex chromosome aneuploidy in females, and patients may present with hypergonadotropic hypogonadism due to gonadal dysgenesis. Timing and modalities of pubertal induction in these patients is still a matter of debate. Aim of this review was to focus on the latest update on pubertal induction in TS. Based on literature data, the following practical approach to this issue is recommended. Pubertal induction should begin between 11 and 12 years of age, starting with low doses of estradiol to preserve height potential. Transdermal 17β-Estradiol (17β-E2) could represent the first-choice induction regimen as it is more physiologic compared to an oral regimen and avoids the first-pass mechanism in the liver. In the case of poor compliance, administration of oral 17β-E2 or ethinyl estradiol could be offered. Incremental dose increases, approximately every 6 months, can contribute to mimic normal pubertal progression until adult dosing is reached over a 2- to 3-year period. Progestin should be added once breakthrough bleeding occurs or after 2 to 3 years of estrogen therapy or if ultrasound shows a mature uterus with thick endometrium. Treatment needs to be individualized and monitored by clinical assessment in relation to patient compliance and satisfaction. Well-designed prospective randomized clinical trials aimed to identify the best estrogen regimen for pubertal induction in TS girls are needed.
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Affiliation(s)
- Tommaso Aversa
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy -
| | - Domenico Corica
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Giorgia Pepe
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Giovanni B Pajno
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Mariella Valenzise
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Maria F Messina
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy
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2
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Cameron-Pimblett A, Davies MC, Burt E, Talaulikar VS, La Rosa C, King TFJ, Conway GS. Effects of Estrogen Therapies on Outcomes in Turner Syndrome: Assessment of Induction of Puberty and Adult Estrogen Use. J Clin Endocrinol Metab 2019; 104:2820-2826. [PMID: 30726925 DOI: 10.1210/jc.2018-02137] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/01/2019] [Indexed: 12/27/2022]
Abstract
CONTEXT Turner syndrome (TS) is often associated with delayed puberty. To induce puberty, estrogen is administered in incremental doses at an age determined by age of presentation. After puberty, various types of maintenance estrogen replacement therapy (ERT) are used. OBJECTIVE We sought associations between age of induction of puberty and type of ERT on adult health outcomes. DESIGN Health surveillance data included blood profiles, bone density, and blood pressure. We assessed interactions between these data and age at first estrogen exposure in women with primary amenorrhea. We also assessed these data according to ERT subgroups [combined oral contraceptive pill (OCP), oral estrogen (OE), and transdermal estradiol (TE)] using data from each of 6679 clinic visits, controlling for age, body mass index, and height. SETTING Adult TS clinic at University College London Hospital. PATIENTS Of 799 women with TS, 624 had primary amenorrhea and 599 had accurate maintenance ERT data. MAIN OUTCOME MEASURES Parameters of health surveillance derived from clinical guidelines. RESULTS Estrogen start age was negatively correlated with adult bone density (spine: r = -0.20 and hip: r = -0.022; P ≤ 0.001). OCP users had higher blood pressure and an adverse lipid profile compared with other ERT subgroups. TE was associated with elevated liver enzymes and hemoglobin A1c compared with OE (P ≤ 0.01). CONCLUSIONS An earlier age of induction of puberty may be beneficial for adult bone density. Given the high prevalence of hypertension in TS, the use of OCP for ERT should be limited. OE may be a benefit for steatohepatitis.
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Affiliation(s)
| | - Melanie C Davies
- Reproductive Medicine Unit, University College London Hospital, London, United Kingdom
| | - Elizabeth Burt
- Reproductive Medicine Unit, University College London Hospital, London, United Kingdom
| | | | - Clementina La Rosa
- Reproductive Medicine Unit, University College London Hospital, London, United Kingdom
| | - Thomas F J King
- Reproductive Medicine Unit, University College London Hospital, London, United Kingdom
| | - Gerard S Conway
- Reproductive Medicine Unit, University College London Hospital, London, United Kingdom
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3
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Young J, Xu C, Papadakis GE, Acierno JS, Maione L, Hietamäki J, Raivio T, Pitteloud N. Clinical Management of Congenital Hypogonadotropic Hypogonadism. Endocr Rev 2019; 40:669-710. [PMID: 30698671 DOI: 10.1210/er.2018-00116] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/05/2018] [Indexed: 12/12/2022]
Abstract
The initiation and maintenance of reproductive capacity in humans is dependent on pulsatile secretion of the hypothalamic hormone GnRH. Congenital hypogonadotropic hypogonadism (CHH) is a rare disorder that results from the failure of the normal episodic GnRH secretion, leading to delayed puberty and infertility. CHH can be associated with an absent sense of smell, also termed Kallmann syndrome, or with other anomalies. CHH is characterized by rich genetic heterogeneity, with mutations in >30 genes identified to date acting either alone or in combination. CHH can be challenging to diagnose, particularly in early adolescence where the clinical picture mirrors that of constitutional delay of growth and puberty. Timely diagnosis and treatment will induce puberty, leading to improved sexual, bone, metabolic, and psychological health. In most cases, patients require lifelong treatment, yet a notable portion of male patients (∼10% to 20%) exhibit a spontaneous recovery of their reproductive function. Finally, fertility can be induced with pulsatile GnRH treatment or gonadotropin regimens in most patients. In summary, this review is a comprehensive synthesis of the current literature available regarding the diagnosis, patient management, and genetic foundations of CHH relative to normal reproductive development.
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Affiliation(s)
- Jacques Young
- University of Paris-Sud, Paris-Sud Medical School, Le Kremlin-Bicêtre, France.,Department of Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Bicêtre Hôpital, Le Kremlin-Bicêtre, France.,INSERM Unité 1185, Le Kremlin-Bicêtre, France
| | - Cheng Xu
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Georgios E Papadakis
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - James S Acierno
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Luigi Maione
- University of Paris-Sud, Paris-Sud Medical School, Le Kremlin-Bicêtre, France.,Department of Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Bicêtre Hôpital, Le Kremlin-Bicêtre, France.,INSERM Unité 1185, Le Kremlin-Bicêtre, France
| | - Johanna Hietamäki
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Translational Stem Cell Biology and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Taneli Raivio
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Translational Stem Cell Biology and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Nelly Pitteloud
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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4
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Matthews D, Bath L, Högler W, Mason A, Smyth A, Skae M. Hormone supplementation for pubertal induction in girls. Arch Dis Child 2017; 102:975-980. [PMID: 28446424 DOI: 10.1136/archdischild-2016-311372] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 03/28/2017] [Accepted: 03/31/2017] [Indexed: 11/04/2022]
Abstract
Pubertal induction in girls with ovarian insufficiency aims to mimic normal puberty, a highly complex process. Here we amalgamate the sparse global evidence and propose three options for pubertal induction regimens including oral ethinyloestradiol, and oral and transdermal 17β-oestradiol. The introduction of progestogens is discussed and the transition to hormone supplementation for adult women. The merits and disadvantages of the different options are detailed. The available evidence indicates that transdermal 17β-oestradiol has the most favourable efficacy, safety and cost profile but randomised controlled trials are urgently required to determine which regimen provides the best clinical outcomes.
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Affiliation(s)
- Debbie Matthews
- Department of Child Health, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Louise Bath
- Department of Endocrinology and Diabetes, Royal Hospital for Sick Children, Edinburgh, Scotland
| | - Wolfgang Högler
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Avril Mason
- Developmental Endocrinology Research Group, Royal Hospital for Children, Glasgow, UK
| | - Arlene Smyth
- Executive Officer Turner Syndrome Support Society, Clydebank Business Park, Glasgow, UK
| | - Mars Skae
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.,Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
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5
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Abstract
Girls and women with Turner's syndrome who come to medical attention older than 12 years present a challenge of medical management. Puberty is already delayed and some compromises have to be made in adjusting the timing of artificially induced puberty to optimise overall outcome with respect to stature, secondary sex characteristics, and psychosocial endpoints. Additionally, individuals who present with primary amenorrhoea to adult services might miss the opportunity for effective growth hormone treatment. Further, induction of puberty regimens lack an evidence base or even clear guidelines for the timing and dose of oestrogen replacement. We have searched the scientific literature to inform management of Turner's syndrome.
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Affiliation(s)
- Marilyn Cheng Lee
- Institute for Women's Health, University College London, London, UK.
| | - Gerard S Conway
- Institute for Women's Health, University College London, London, UK
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6
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Sørensen SD, Greve T, Wielenga VT, Wallace WHB, Andersen CY. Safety considerations for transplanting cryopreserved ovarian tissue to restore fertility in female patients who have recovered from Ewing’s sarcoma. Future Oncol 2014; 10:277-83. [DOI: 10.2217/fon.13.183] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Ewing’s sarcoma (EWS) is a highly malignant cancer in children, adolescents and young adults. The chemotherapy required to treat female EWS patients may cause primary ovarian insufficiency and infertility as a side effect. Cryopreservation of ovarian tissue before the start of chemotherapy can potentially preserve fertility. When the patient has been cured and primary ovarian insufficiency has developed, transplantation of frozen/thawed ovarian tissue can restore ovarian function. The tissue is usually collected before chemotherapy is initiated, and malignant cells may contaminate the stored ovarian tissue, potentially causing recrudescence of the original cancer after transplantation. The risk of EWS metastasizing to the ovary is probably low but has not been studied in great detail. This review describes the available evidence on the risk of malignant cell contamination in the ovaries of EWS patients and presents a new case of malignant cells in an ovarian biopsy from a girl with EWS.
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Affiliation(s)
- Stine D Sørensen
- Laboratory of Reproductive Biology, Rigshospitalet – Copenhagen University Hospital, Denmark
| | - Tine Greve
- Laboratory of Reproductive Biology, Rigshospitalet – Copenhagen University Hospital, Denmark
| | | | - W Hamish B Wallace
- Department of Haematology/Oncology, Royal Hospital for Sick Children, 17 Millerfield Place, Edinburgh, EH9 1LW, UK
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, Rigshospitalet – Copenhagen University Hospital, Denmark
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7
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Capalbo D, Improda N, Esposito A, De Martino L, Barbieri F, Betterle C, Pignata C, Salerno M. Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy from the pediatric perspective. J Endocrinol Invest 2013; 36:903-12. [PMID: 23723078 DOI: 10.3275/8999] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare autosomal recessive disease caused by mutations of the AutoImmune REgulator gene. The clinical spectrum of the disease encompasses several autoimmune endocrine and non-endocrine manifestations, which may lead to acute metabolic alterations and eventually life-threatening events. The clinical diagnosis is defined by the presence of at least two components of the classic triad including chronic mucocoutaneous candidiasis (CMC), chronic hypoparathyroidism (CH), Addison's disease (AD). Other common features of the disease are hypergonadotropic hypogonadism, alopecia, vitiligo, autoimmune hepatitis, Type 1 diabetes, gastrointestinal dysfunction. APECED usually begins in childhood. CMC is the first manifestation to appear, usually before the age of 5 yr, followed by CH and then by AD. The clinical phenotype may evolve over several years and many components of the disease may not appear until the 4th or 5th decade of life. The phenotypical expression of the syndrome shows a wide variability even between siblings with the same genotype. In view of this heterogeneity, an early diagnosis of APECED can be very challenging often leading to a considerable diagnostic delay. Therefore, clinicians should be aware that the presence of even a minor component of APECED in children should prompt a careful investigation for other signs and symptoms of the disease, thus allowing an early diagnosis and prevention of severe and life-threatening events. Aim of this review is to focus on clinical presentation, diagnosis and management of the major components of APECED in children particularly focusing on endocrine features of the disease.
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Affiliation(s)
- D Capalbo
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University "Federico II" of Naples, Naples, Italy
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8
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Anderson RA, Hindmarsh PC, Wallace WHB. Induction of puberty by autograft of cryopreserved ovarian tissue in a patient previously treated for Ewing sarcoma. Eur J Cancer 2013; 49:2960-1. [PMID: 23731831 DOI: 10.1016/j.ejca.2013.04.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 04/03/2013] [Indexed: 11/19/2022]
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9
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Phelan N, Conway SH, Llahana S, Conway GS. Quantification of the adverse effect of ethinylestradiol containing oral contraceptive pills when used in conjunction with growth hormone replacement in routine practice. Clin Endocrinol (Oxf) 2012; 76:729-33. [PMID: 22098528 DOI: 10.1111/j.1365-2265.2011.04277.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Oestrogen antagonizes the action of growth hormone (GH). For women with combined GH and oestrogen deficiency, transdermal oestradiol is more favourable in this regard compared to oral oestradiol. Oral contraceptive pills containing ethinylestradiol (EE) are commonly used in young women with GHD and there is little information on the impact of this form of oestrogen. DESIGN A case note review of women with growth hormone deficiency (GHD) attending a tertiary endocrine clinic comparing the dose of GH and serum insulin-like growth factor 1 concentrations and the type of exogenous oestrogen. METHODS All women with GHD between the ages of 18 and 47 attending University College London Hospitals (UCLH) were included and grouped according to type of oestrogen replacement. Weight, GH dose and serum IGF-I concentrations were recorded at 121 visits in 88 women. RESULTS The daily dose of GH was significantly higher and the GH responsivity was significantly lower in the EE group compared to those taking no oestrogen and transdermal oestrogen. The additional cost of GH for women using EE compared to transdermal oestradiol was £6016 per patient per year. Effectiveness of GH improved in all women changing from EE to another form of oestrogen. CONCLUSION Use of oral contraceptive pills containing EE should be avoided in women receiving treatment with GH. Alternative options include oral or transdermal hormone replacement therapy (HRT) preparations for those that require oestrogen replacement or a progesterone-based regimen for contraceptive purposes.
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MESH Headings
- Adolescent
- Adult
- Body Weight/drug effects
- Contraceptives, Oral/administration & dosage
- Contraceptives, Oral/therapeutic use
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/therapeutic use
- Dose-Response Relationship, Drug
- Drug Therapy, Combination
- Estrogens/adverse effects
- Estrogens/deficiency
- Estrogens/therapeutic use
- Ethinyl Estradiol/administration & dosage
- Ethinyl Estradiol/adverse effects
- Ethinyl Estradiol/therapeutic use
- Female
- Hormone Replacement Therapy/economics
- Hormone Replacement Therapy/methods
- Human Growth Hormone/antagonists & inhibitors
- Human Growth Hormone/deficiency
- Human Growth Hormone/therapeutic use
- Humans
- Injections, Intradermal
- Insulin-Like Growth Factor I/metabolism
- Middle Aged
- Outcome Assessment, Health Care/economics
- Outcome Assessment, Health Care/methods
- Retrospective Studies
- Young Adult
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Affiliation(s)
- Niamh Phelan
- Department of Endocrinology, University College London Hospitals, London, UK
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10
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Grant P, Lipscomb D. Primary amenorrhoea due to ovarian dysgenesis: a previously undescribed chromosome 12 abnormality. BMJ Case Rep 2011; 2011:2011/jan03_1/bcr0720103201. [PMID: 22715224 DOI: 10.1136/bcr.07.2010.3201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This case describes for the first time a de novo chromosomal abnormality (46, XX, inv dup del(12)(qter-p13.3::p13.3-p12.3:)dn.ish inv dup del(12)(TEL-ETV6++) which produced the phenotype of a female with primary ovarian failure and subsequent osteopenia in early adult life. This warranted treatment with oestrogen replacement therapy and close supportive monitoring.
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Affiliation(s)
- Paul Grant
- Department of Diabetes and Endocrinology, Royal Sussex County Hospital, Brighton, East Sussex, UK.
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Gelbaya T, Vitthala S, Nardo L, Seif M. Optimizing hormone therapy for future reproductive performance in women with premature ovarian failure. Gynecol Endocrinol 2011; 27:1-7. [PMID: 20608810 DOI: 10.3109/09513590.2010.501875] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
With increasing success in treatment of childhood cancer there is a growing population of women with premature ovarian failure (POF) seeking fertility treatment. Various preparations of estrogen and progestogen are prescribed for young women with POF. While the dose and duration of hormone therapy (HT) is usually adjusted according to the patient's height and the Tanner's stage of development for young pre-pubertal women, the optimal effective HT regimen to maximise the reproductive potential for young as well as for the older age group remains unclear. Furthermore, there is a paucity of evidence to support the preferential effectiveness of the different regimens used. Assisted reproduction using donated gametes or embryos remains the only realistic option to enable women with POF to conceive. Successful outcomes are primarily dependant on successful implantation and placentation. Consequently, the success of assisted reproduction is determined by uterine and endometrial development, which is largely influenced by the modality of HT as well as the age at which it is commenced. In this review, we critically appraise the current practices and published data for management of women with POF. We aim to focus on the effect of HT on uterine development in women with primary and irreversible POF.
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Affiliation(s)
- Tarek Gelbaya
- Leicester Fertility Centre, University Hospitals of Leicester, Leicester, UK.
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12
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Cheikhelard A, Thibaud E, Morel Y, Jaubert F, Lortat-Jacob S, Polak M, Nihoul-Fekete C. Complete androgen insensitivity syndrome: diagnosis and management. Expert Rev Endocrinol Metab 2009; 4:565-573. [PMID: 30780790 DOI: 10.1586/eem.09.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Complete androgen insensitivity syndrome (CAIS) is an X-linked genetic disorder affecting 46,XY individuals, characterized by the loss of function of the androgen receptor gene resulting in complete peripheral androgen resistance. Patients have a nonambiguous female phenotype with normal female external genitalia. Gonads are undescended testes (either intra-abdominal or inguinal), there is no uterus and the length of the vagina is usually very short. Gender identity is always female. This review focuses on the importance of accurate diagnosis of CAIS versus partial androgen insensitivity syndrome and other disorders of sex development by genotyping the androgen receptor, and raises issues of the optimal management of these patients. In the era of the Consensus Statement on Management of Intersex Disorders, we provide new insights into CAIS screening, surgical management of the gonads (balancing between hormonal production and malignancy risk) and of vaginal adequacy, and the ethics concerned with the disclosure to patients and their families.
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Affiliation(s)
- Alaa Cheikhelard
- a Department of Pediatric Surgery and Urology, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France and Centre de Référence des Pathologies Gynécologiques Rares, AP-HP Hôpital Necker Enfants-malades, Paris, France.
| | - Elisabeth Thibaud
- b Department of Pediatric Endocrinology and Gynaecology, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France and Centre de Référence des Pathologies Gynécologiques Rares, AP-HP Hôpital Necker Enfants-malades, Paris, France
| | - Yves Morel
- c Department of Molecular Biology and Hormonology, Université Claude Bernard Lyon 1, Lyon, France
| | - Francis Jaubert
- d Department of Cytology and Pathology, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, Paris, France and Université Paris Descartes, Paris, France
| | - Stephen Lortat-Jacob
- e Department of Pediatric Surgery and Urology, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France
| | - Michel Polak
- f Centre de Référence des Pathologies Gynécologiques Rares, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France and Department of Pediatric Endocrinology and Gynaecology, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France and Université Paris Descartes, Paris, France
| | - Claire Nihoul-Fekete
- g Department of Pediatric Surgery and Urology and Centre de Référence des Pathologies Gynécologiques Rares, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France and Université Paris Descartes, Paris, France
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