Editor,—The recent interesting and valuable article by Johnston and colleagues1 describing the outcome of a trial of recombinant growth hormone (GH) and low dose oestrogen in girls with Turner syndrome (TS) concluded that low dose oestrogen before planned induction of puberty was not beneficial for adult height. However, they extend their conclusions by the cautious word that although the majority of girls might benefit from GH treatment, a “realistic appraisal” suggests “modest” benefit. Although evidence to the contrary is fully discussed in their paper, this generalisation might lead the reader to doubt the efficacy of GH in TS.

The best known of the trials of GH in TS is that of Rosenfeld and colleagues2 who followed their patients until the age of 17–18 years (near final height). Although they started this trial with a randomised untreated control arm who grew at a rate of 3.8 cm per year in contrast to girls in the treatment arms who grew more rapidly, the former were placed in a treatment arm of …