title: Effect of oxandrolone and timing of oral ethinylestradiol initiation on pubertal progression, height velocity and bone maturation in the UK Turner study.
abstract: BACKGROUND
  A UK study showed final height in Turner syndrome (TS) girls receiving growth hormone is affected by age at pubertal induction and oxandrolone (Ox). Using data from that study, we analysed the effect of timing of oral ethinylestradiol (EE2) and Ox on height velocity (HV), bone maturation and pubertal progression, and compared growth response in EE2-treated versus spontaneous puberty.
  
  
  METHODS
  Analysis of HV, bone age and pubertal stage in 92 TS girls (7-13 years) randomised to Ox (0.05 mg/kg/day; max: 2.5 mg/day) or placebo from 9 years, and EE2 (year 1: 2 µg/day; year 2: 4 µg/day; year 3: 6/8/10 µg/day×4 months) or placebo at 12 years with EE2 at 14 years. Girls enrolled at >12.25 years received EE2 at 14 years ('late group').
  
  
  RESULTS
  Fifty-six girls were randomised to EE2 at 12 years (n=28, 11 Ox) or 14 years (n=28, 13 Ox); there were 19 girls in the late group (9 Ox) and 17 girls with spontaneous puberty (10 Ox). Girls receiving EE2 at 12 versus 14 years had faster bone maturation, but neither group showed acceleration. Ox increased HV without altering bone maturation or pubertal progression. Girls with spontaneous puberty had greater pubertal growth (mean PHV 8.5 cm/year; p<0.001) and height gain (p<0.001) than EE2-treated girls despite similar mean enrolment height SD and dysmorphology scores.
  
  
  CONCLUSIONS
  Pubertal induction with EE2 does not replicate the acceleration observed in unaffected girls or TS girls with spontaneous puberty.
authors.affiliation: University of Glasgow Department of Child Health, Royal Hospital for Sick Children, Glasgow, UK.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Perry
authors.forename: Emma Jane
authors.initials: EJ
authors.lastname: Gault
authors.forename: Wendy F
authors.initials: WF
authors.lastname: Paterson
authors.forename: David B
authors.initials: DB
authors.lastname: Dunger
authors.forename: Malcolm D C
authors.initials: MD
authors.lastname: Donaldson
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000728:Androgens / Q000008:administration & dosage*; D004967:Estrogens / Q000008:administration & dosage*; D004997:Ethinyl Estradiol; D005260:Female; D006801:Humans; D010074:Oxandrolone / Q000008:administration & dosage*; D011627:Puberty / Q000187:drug effects*; D014424:Turner Syndrome / Q000188:drug therapy* / Q000503:physiopathology*; D006113:United Kingdom
chemical_list: D000728:Androgens; D004967:Estrogens; D004997:Ethinyl Estradiol; D010074:Oxandrolone