Adult height and pubertal growth in Turner syndrome after treatment with recombinant growth hormone.
OBJECTIVE
The objective of this study was to evaluate factors affecting adult height (AH) in patients with Turner syndrome treated with GH.


METHODS
The study design was a population-based cohort study.


METHODS
The setting was The StaTur Study, a register of patients treated in France between 1986 and 1997, followed for a mean of 9.3 yr.


METHODS
We followed 704 of the 891 eligible patients (79%) to AH.


METHODS
GH (0.8 +/- 0.2 IU/kg.wk; 0.26 +/- 0.06 mg/kg.wk; mean +/- sd) was administered for 5.0 +/- 2.2 yr. Puberty was classified as spontaneous (10%), spontaneous with secondary estrogens (13%), or induced (77%). Estrogen treatment was initiated at 15.0 +/- 1.9 yr of age in those with induced puberty.


METHODS
The main outcome measure was multivariate analysis of AH after grouping potential predictors.


RESULTS
The mean AH was 149.9 +/- 6.1 cm, 8.5 cm above projected height. The model explained 90% of the variance, with major effects of age at initiation and duration of treatment. Other factors included birth length, target height, bone age delay and weight at initiation of treatment, age at pubertal onset, GH dose, and number of injections per week. Age at introduction of estrogens was not a predictor, and the use of percutaneous vs. oral estrogens was associated with greater height (+2.1 cm; 95% confidence interval, 1.00-3.25).


CONCLUSIONS
Our results support the early initiation of GH treatment and induction of puberty at a physiological age to achieve optimal AH. They suggest that GH should be injected daily, and percutaneous estrogens used. These results should be considered in the context of the lack of demonstrable influence of AH on psycho-social outcomes, uncertainties regarding long-term safety, and treatment cost.
Pediatric Endocrinology and Institut National de la Santé et de la Recherche Médicale, Unité 561, Groupe Hospitalier Cochin-Saint Vincent de Paul, 82 avenue Denfert Rochereau, 75014 Paris, France.
Leandro
L
Soriano-Guillen
Joël
J
Coste
Emmanuel
E
Ecosse
Juliane
J
Léger
Maïté
M
Tauber
Sylvie
S
Cabrol
Marc
M
Nicolino
Raja
R
Brauner
Jean-Louis
JL
Chaussain
Jean-Claude
JC
Carel
D000293:Adolescent; D001827:Body Height; D002648:Child; D015331:Cohort Studies; D004334:Drug Administration Schedule; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D006128:Growth / Q000187:drug effects; D019382:Human Growth Hormone / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D008954:Models, Biological; D015999:Multivariate Analysis; D011627:Puberty; D014424:Turner Syndrome / Q000188:drug therapy* / Q000503:physiopathology*
D004967:Estrogens; D019382:Human Growth Hormone