title: Final height in girls with turner syndrome after long-term growth hormone treatment in three dosages and low dose estrogens.
abstract: Although GH treatment for short stature in Turner syndrome is an accepted treatment in many countries, which GH dosage to use and which age to start puberty induction are issues of debate. This study shows final height (FH) in 60 girls with Turner syndrome treated in a randomized dose-response trial, combining GH treatment with low dose estrogens at a relatively young age. Girls were randomly assigned to group A (4 IU/m(2).d; approximately 0.045 mg/kg/d), group B (first year, 4 IU/m(2).d; thereafter 6 IU/m(2).d), or group C (first year, 4 IU/m(2).d; second year, 6 IU/m(2).d; thereafter, 8 IU/m(2).d). After a minimum of 4 yr of GH treatment, at a mean age of 12.7 +/- 0.7 yr, low dose micronized 17beta-estradiol was given orally. After a mean duration of GH treatment of 8.6 +/- 1.9 yr, FH was reached at a mean age of 15.8 +/- 0.9 yr. FH, expressed in centimeters or SD score, was 157.6 +/- 6.5 or -1.6 +/- 1.0 in group A, 162.9 +/- 6.1 or -0.7 +/- 1.0 in group B, and 163.6 +/- 6.0 or -0.6 +/- 1.0 in group C. The difference in FH in centimeters, corrected for height SD score and age at start of treatment, was significant between groups A and B [regression coefficient, 4.1; 95% confidence interval (CI), 1.4, 6.9; P < 0.01], and groups A and C (coefficient, 5.0; 95% CI, 2.3, 7.7; P < 0.001), but not between groups B and C (coefficient, 0.9; 95% CI, -1.8, 3.6). Fifty of the 60 girls (83%) had reached a normal FH (FH SD score, more than -2). After starting estrogen treatment, the decrease in height velocity (HV) changed significantly to a stable HV, without affecting bone maturation (change in bone age/change in chronological age). The following variables contributed significantly to predicting FH SD score: GH dose, height SD score (ref. normal girls), chronological age at start of treatment, and HV in the first year of GH treatment. GH treatment was well tolerated. In conclusion, GH treatment leads to a normalization of FH in most girls, even when puberty is induced at a normal pubertal age. The optimal GH dosage depends on height and age at the start of treatment and first year HV.
authors.affiliation: Department of Pediatrics, Division of Endocrinology, Erasmus University MC/Sophia Children's Hospital, 3015 GJ Rotterdam, The Netherlands. vanpareren@zonnet.nl
authors.forename: Yvonne K
authors.initials: YK
authors.lastname: van Pareren
authors.forename: Sabine M P F
authors.initials: SM
authors.lastname: de Muinck Keizer-Schrama
authors.forename: Theo
authors.initials: T
authors.lastname: Stijnen
authors.forename: Theo C J
authors.initials: TC
authors.lastname: Sas
authors.forename: Maarten
authors.initials: M
authors.lastname: Jansen
authors.forename: Barto J
authors.initials: BJ
authors.lastname: Otten
authors.forename: J J Gera
authors.initials: JJ
authors.lastname: Hoorweg-Nijman
authors.forename: Thomas
authors.initials: T
authors.lastname: Vulsma
authors.forename: Wilhelmina H
authors.initials: WH
authors.lastname: Stokvis-Brantsma
authors.forename: Catrienus W
authors.initials: CW
authors.lastname: Rouwé
authors.forename: H Maarten
authors.initials: HM
authors.lastname: Reeser
authors.forename: Willem-Jan
authors.initials: WJ
authors.lastname: Gerver
authors.forename: Jos J
authors.initials: JJ
authors.lastname: Gosen
authors.forename: Ciska
authors.initials: C
authors.lastname: Rongen-Westerlaken
authors.forename: Stenvert L S
authors.initials: SL
authors.lastname: Drop
mesh_terms: D001827:Body Height / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004958:Estradiol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D019382:Human Growth Hormone / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D014424:Turner Syndrome / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D019382:Human Growth Hormone; D004958:Estradiol; D007334:Insulin-Like Growth Factor I