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Growth-Promoting Effect of Growth Hormone and Low Dose Ethinyl Estradiol in Girls with Turner's Syndrome^*

Departments of Pediatrics, Universities of Leuven (M.V.-L., G.M.), Louvain (M.M., P.M.), Ghent (M.C.), Brussels (G. V. V.) and Liege (C.H.) Belgium

Address all correspondence and requests for reprints to: M. Vanderschueren-Lodeweyckx, Department of Pediatrics, University Hospital Gasthuisberg, Herestraat 49, B 3000 Leuven, Belgium.

Forty patients with Turner's syndrome, aged 5.0–16.6 yr, were randomly allocated to receive daily sc injections of recombinant human GH (hGH) at a dose of 1 IU/kg·week alone (group I) or in combination with 25 ng/kg·day ethinyl estradiol (E₂; group II). The mean pretreatment height velocity was 3.8 cm/yr for both groups. During the first year of treatment height velocity increased significantly (P < 0.001) in both groups, to 7.5 ± 1.3 and 8.1 ± 1.6 cm/yr, respectively. The difference between the two groups was not significant. The mean (±SD) height velocity expressed as the SD score for chronological age (Turner references) was 0.0 ± 1.2 for group I and 0.2 ± 1.4 for group II and increased significantly (P < 0.001) during the first year of treatment to +4.3 ± 1.1 in group I and +5.4 ± 1.2 group II. The difference between both groups was statistically significant (P < 0.01). Height SD score for chronological age (Turner references) increased from –0.2 ± 0.9 to +0.6 ± 1.0 in group I and from –0.2 ± 1.0 to +0.7 ± 1.1 in group II. Mean bone age progressed similarly in both treatment groups (1.1 ± 0.6 yr during 1 yr of treatment). However, bone age maturation accelerated more rapidly in younger patients. Twelve girls (three in group I and nine in group II) had minor breast development. No major adverse effects were reported. We conclude that daily sc therapy with hGH stimulates height velocity in Turner's syndrome. The beneficial effect on height velocity increment of E₂ addition was small. Furthermore, even very low doses of E₂ may induce breast development at an early age and accelerate bone maturation. For these reasons, the addition of E₂ to hGH is not warranted in young patients with Turner's syndrome.

^* Presented in part at the KabiVitrum Sixth International Symposium on Growth and Growth Disorders, Brussels, Belgium, October 1988. This work was supported in part by a grant from the Belgian National Fonds voor Geneeskundig Wetenschappelijk Onderzoek (3,0047,89) and by Kabi (Belgium and Sweden).

Received May 18, 1989.

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