Growth hormone therapy in Turner's syndrome. Impact of injection frequency and initial bone age.
OBJECTIVE
To determine the influence of the injection frequency and the initial bone age on the efficacy of treatment with biosynthetic growth hormone in Turner's syndrome.


METHODS
Randomized study.


METHODS
Referral-based pediatric endocrinology departments of seven university medical centers.


METHODS
Fifty-two patients with Turner's syndrome confirmed with chromosomal analysis.


METHODS
Somatotropin recombinant DNA (24 IU/m2 of body surface area) subcutaneously administered in three or six injections per week for 2 years. Patients who were older than 12 years at the beginning of the study received low doses of estrogen.


RESULTS
The following statistically significant findings supported the use of six injections per week compared with three injections per week: the mean (+/- SD) increment in height during 2 years was 11.3 cm (3.8 cm) with six injections vs 8.6 cm (3.4 cm) with three injections; the increment in height standard deviation score was 0.9 cm (0.5 cm) vs 0.6 cm (0.3 cm); the growth velocity was 6.6 cm/y (2.0 cm/y) vs 5.2 cm/y (1.7 cm/y) in year 1 and 4.7 cm/y (2.0 cm/y) vs 3.4 cm/y (1.7 cm/y) in year 2; and the increment in height standard deviation score for bone age was 0.8 cm (0.5 cm) vs 0.4 cm (0.6 cm). For patients whose initial bone age was more than 13 years, growth velocity increased by 1 to 2 cm in year 1; in year 2 no increment was observed. We did not observe adverse effects.


CONCLUSIONS
Biosynthetic growth hormone in a higher-frequency regimen in Turner's syndrome is more efficient in terms of increment in height, growth velocity, and height standard deviation score for bone age than treatment in a lower-frequency regimen. In patients with an initial bone age of more than 13 years, the response was poor. Longer follow-up is necessary to assess the effect on final height.
Rongen-Westerlaken
C
C
Department of Pediatrics, University of Utrecht, The Netherlands.
van Es
A
A
Wit
J M
JM
Otten
B J
BJ
De Muinck Keizer-Schrama
S M
SM
Drayer
N M
NM
Oostdijk
W
W
Delemarre-vd Waal
H A
HA
Gons
M H
MH
Waelkens
J J
JJ
D000293:Adolescent; D000365:Age Determination by Skeleton; D000367:Age Factors; D001827:Body Height / Q000187:drug effects; D001830:Body Surface Area; D002648:Child; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004967:Estrogens / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006128:Growth / Q000187:drug effects; D013006:Growth Hormone / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006785:Hospitals, University; D006801:Humans; D007279:Injections, Subcutaneous; D009426:Netherlands; D014424:Turner Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
D004967:Estrogens; D013006:Growth Hormone