Final height in young women with Turner syndrome after GH therapy: an open controlled study

Abstract

GH therapy has been applied to patients with Turner syndrome for over a decade, but small sample size, delayed initiation of therapy into adolescent age and comparison with historical control subjects limit the usefulness of these studies for appraisal of the effect of GH on final adult height. We report 49 young women with Turner syndrome who completed a clinical trial in an open, non-randomized, agematched controlled study of GH, given as daily s.c. injections at a weekly dose of 8.2 mg/m 2 for 1.9-7.5 years. Final height was defined as the measurement taken 2 years or more after height velocity declined below 2 cm/year and after a bone age of 15 'years'. The gain in height was evaluated in three ways. The mean final height gain, compared with the control group, was 4.4 cm. When corrected for the projected height at inception of therapy, the mean gained height was 5.3 cm above the control group. Shorter girls showed better response to GH then did taller girls. After correcting for parental height, the mean gain was 4.7 cm. The adult height of the GH-treated Turner women was significantly correlated with the target height, whereas no such correlation was obtained for control untreated women. Furthermore, no correlation was observed between height gain and the age or duration of GH therapy, or the age of inception of estrogen replacement therapy. It is concluded that GH therapy augments final height of girls with Turner syndrome by a mean 4.4-5.3 cm, depending on the method of evaluation, and that shorter girls may be preferred candidates for such therapy. GH therapy can be initiated after age 10 years and there is no reason to delay estrogen therapy beyond the age of 12. Indirect evidence suggests that high-dose GH therapy may surmount a pathophysiological resistance in the GH-IGF-I axis.

Individualised vs fixed dose of oral 17β-oestradiol for induction of puberty in girls with Turner syndrome: an open-randomised parallel trial

“…This is a relatively late age for starting puberty but it is in concordance with the current prescribing practice published in recent questionnaires (12,13) and with other studies (28,29). Pubic hair appeared before oestrogen was initiated in nearly all girls from both groups and progressed similar to other studies (30).…”

Growth hormone treatment before the age of 4 years prevents short stature in young girls with Turner syndrome

“…A number of other studies investigating the use of GH therapy in girls with TS have reported that treatment has a greater effect on growth in shorter girls than it does in girls with a smaller height deficit before treatment (22,25,30). In this study, girls with greater height at baseline grew less than those with a shorter height; this may be explained by the dose of r-hGH used, depending on the height of the girl at entry to the study.…”

The Uterine Length in Women with Turner Syndrome Reflects the Postmenarcheal Daily Estrogen Dose

“…The strategy of using estrogen replacement to facilitate optimal growth in such girls has been discussed elsewhere [6, 7, 8, 9, 10]. Thus determining an estrogen replacement schedule for optimal concurrent use with growth hormone therapy has become a practical issue for patients with TS [6].…”