Elsevier

The Journal of Pediatrics

Volume 132, Issue 2, February 1998, Pages 319-324
The Journal of Pediatrics

Growth hormone therapy of Turner's syndrome: Beneficial effect on adult height,☆☆,,★★,

https://doi.org/10.1016/S0022-3476(98)70452-4Get rights and content

Abstract

Objective: To carry out a multicenter, prospective, randomized trial of human growth hormone (GH), alone or in combination with oxandrolone (OX), in patients with Turner's syndrome (TS). Methods: In an initial phase lasting 12 to 24 months, 70 girls with TS, verified by karyotype, were randomly assigned to one of four groups: (1) observation, (2) OX, (3) GH, or (4) GH plus OX. After completion of the first phase, group 3 subjects continued to receive GH only. All other subjects were treated with GH plus OX. Subjects were followed up until attainment of adult height and/or cessation of treatment. Data from this trial were compared with growth characteristics of 25 American historical subjects with TS (matched for age, height, parental target height, and karyotype) who never received either GH or androgens. Results: Of the 70 subjects enrolled, 60 completed the clinical trial. The 17 subjects receiving GH alone all completed the trial and reached a height of 150.4 ± 5.5 cm (mean ± SD), 8.4 ± 4.5 cm taller than their mean projected adult height at enrollment (95% confidence interval [CI]: 6.3 to 10.6 cm). The 43 subjects receiving GH plus OX attained a mean height of 152.1 ± 5.9 cm, 10.3 ± 4.7 cm taller than their mean projected adult height (95% CI: 8.9 to 11.7 cm). The historical control subjects had a mean adult height of 144.2 ± 6.0 cm, precisely matching their original projected adult height of 144.2 ± 6.1 cm. Conclusions: GH, either alone or in combination with OX, is capable of stimulating short-term growth and augmenting adult height in girls with TS. With early diagnosis and initiation of treatment, an adult height of more than 150 cm is a reasonable goal for most girls with TS. (J Pediatr 1998;132:319-24)

Section snippets

Methods

Seventy girls with TS were enrolled in a prospective study, after informed consent had been obtained (Table I). At entry, chronologic age ranged from 4.7 to 12.4 years (mean age, 9.3 years). Mean skeletal age, according to the standards of Greulich and Pyle,7 was 8.0 years, with a maximal bone age of 11.2 years. Chromosome analysis demonstrated a 45,X karyotype in 76% of subjects, structural abnormalities of the X chromosome in 9%, and mosaicism in 15%. Heights at entry were at least 1 standard

Results

Baseline ages, heights, TS height SDS, and mid-parental target heights were not significantly different between the group receiving GH alone and the group receiving combination therapy (Table II).

. Response to GH treatment

Empty CellGH Rx (n = 17)Combination Rx (n = 43)American retrospective control subjects (n = 25)
Baseline age (yr)9.1 (2.1)9.9 (2.3)9.2 (1.7)
Baseline height (cm)114.6 (9.5)17.3 (10.4)117.1 (8.9)
Baseline TS SD score*-0.2 (0.9)-0.2 (0.9)0.2 (0.9)
Baseline Lyon PAH (cm)142.0 (5.9)141.8 (5.9)

Discussion

The mean adult height attained by the retrospective control subjects (144.2 ± 6.0 cm) exactly matched their original mean projected adult heights (144.2 ± 6.1 cm), further validating the use of the method of Lyon et al.9, 10, 11 for projecting adult height in girls with TS. Fifty-eight of the 62 GH-treated subjects (94%) attained adult heights greater than their projected adult heights. The mean adult height for recipients of GH alone was 150.4 cm, 8.4 ± 4.5 cm above their projected adult

References (20)

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From the Department of Pediatrics, Oregon Health Sciences University, Portland, Oregon; Genentech, Inc., South San Francisco, California; the Department of Pediatrics, Harbor UCLA Medical Center, Torrance, California; the Department of Pediatrics, University of Tennessee Medical Group, Memphis, Tennessee; the Department of Pediatrics, Henry Ford Hospital, Detroit, Michigan; Children's Hospital Medical Center, Cincinnati, Ohio; the Department of Pediatrics, University of Colorado Medical Center, Denver, Colorado; the Department of Pediatrics, UCLA Medical Center, Los Angeles, California; Children's Hospital and Medical Center, Seattle, Washington; Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas; and the Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York.

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Supported in part by Genentech, Inc., which provided both financial and editorial support (K. M. Attie, J. Frane, J, Kuntze, A. J. Johanson).

Drs. Rosenfeld, Brasel, and Lippe have been investigators in trials supported by Genentech, Inc. or the Genentech Foundation; Drs. Rosenfeld, Brasel, Cara, Chernausek, Mahoney, Moore, and Saenger have received grants from Genentech or the Genentech Foundation; Drs. Attie, Frane, Johanson and Joyce Kuntz are or have been employees of Genentech, Inc.

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Reprint requests: Ron G. Rosenfeld, MD, Department of Pediatrics, Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97201.

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