title: Gradually increasing ethinyl estradiol for Turner syndrome may produce good final height but not ideal BMD.
abstract: Estrogen replacement therapy in Turner syndrome should theoretically mimic the physiology of healthy girls. The objective of this study was to describe final height and bone mineral density (BMD) in a group of 17 Turner syndrome patients (group E) who started their ethinyl estradiol therapy with an ultra-low dosage (1-5 ng/kg/day) from 9.8-13.7 years. The subjects in group E had been treated with GH 0.35 mg/kg/week since the average age of 7.4 years. The 30 subjects in group L, one of the historical groups, were given comparable doses of GH, and conjugated estrogen 0.3125 mg/week ∼0.3125 mg/day was initiated at 12.2-18.7 years. The subjects in group S, the other historical group, were 21 patients who experienced breast development and menarche spontaneously. Final height (height gain < 2 cm/year) in group E was 152.4 ± 3.4 cm and the standard deviation (SD) was 2.02 ± 0.62 for Turner syndrome. The final height in group L was 148.5 ± 3.0 cm with a SD of 1.30 ± 0.55, which was significantly different from the values for group E. The volumetric BMD of group S (0.290 ± 0.026 g/cm3) was significantly different from that of group L or E (0.262 or 0.262 g/cm3as a mean, respectively). This is the first study of patients with Turner syndrome where estrogen was administered initially in an ultra-low dose and then increased gradually. Our estrogen therapy in group E produced good final height but not ideal BMD.
authors.affiliation: Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ariyasu
authors.forename: Masako
authors.initials: M
authors.lastname: Izawa
authors.forename: Junko
authors.initials: J
authors.lastname: Igaki-Miyamoto
authors.forename: Mami
authors.initials: M
authors.lastname: Fukuma
authors.forename: Megumi
authors.initials: M
authors.lastname: Hatano
authors.forename: Hiroko
authors.initials: H
authors.lastname: Yagi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Goto
mesh_terms: D000293:Adolescent; D001827:Body Height / Q000187:drug effects*; D015519:Bone Density / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D015914:Estrogen Replacement Therapy / Q000379:methods*; D004997:Ethinyl Estradiol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D019382:Human Growth Hormone / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007564:Japan; D008572:Menarche / Q000187:drug effects; D014424:Turner Syndrome / Q000188:drug therapy*
chemical_list: D019382:Human Growth Hormone; D004997:Ethinyl Estradiol