This Article Full Text Full Text (PDF) All Versions of this Article: 90/9/5197    most recent Author Manuscript (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Soriano-Guillen, L. Articles by Carel, J.-C. Search for Related Content PubMed PubMed Citation Articles by Soriano-Guillen, L. Articles by Carel, J.-C. Related Collections Female Endocrinology Neuroendocrinology and Pituitary Pediatric Endocrinology

Adult Height and Pubertal Growth in Turner Syndrome after Treatment with Recombinant Growth Hormone

Departments of Pediatric Endocrinology (L.S.-G., J.-L.C., J.-C.C.) and Biostatistics (J.C., E.E.) and Institut National de la Santé et de la Recherche Médicale (L.S.-G., J.-L.C., J.-C.C.), Unité 561, Groupe Hospitalier Cochin-Saint Vincent de Paul and Université Paris V, 75014 Paris, France; Department of Pediatric Endocrinology, Hôpital Robert Debré (J.L.), 75935 Paris, France; Department of Pediatric Endocrinology, Hôpital des Enfants (M.T.), 31059 Toulouse, France; Department of Pediatric Endocrinology, Hôpital Armand Trousseau (S.C.), 75571 Paris, France; Department of Pediatric Endocrinology, Hôpital Debrousse (M.N.), 69322 Lyon, France; and Department of Pediatric Endocrinology, Hôpital de Bicêtre (R.B.), 94275 Le Kremlin Bicêtre, France

Address all correspondence and requests for reprints to: Dr. Jean-Claude Carel, Pediatric Endocrinology and Institut National de la Santé et de la Recherche Médicale, Unité 561, Groupe Hospitalier Cochin-Saint Vincent de Paul, 82 avenue Denfert Rochereau, 75014 Paris, France. E-mail: carel{at}paris5.inserm.fr.

Objective: The objective of this study was to evaluate factors affecting adult height (AH) in patients with Turner syndrome treated with GH.

Design: The study design was a population-based cohort study.

Setting: The setting was The StaTur Study, a register of patients treated in France between 1986 and 1997, followed for a mean of 9.3 yr.

Patients: We followed 704 of the 891 eligible patients (79%) to AH.

Intervention: GH (0.8 ± 0.2 IU/kg·wk; 0.26 ± 0.06 mg/kg·wk; mean ± SD) was administered for 5.0 ± 2.2 yr. Puberty was classified as spontaneous (10%), spontaneous with secondary estrogens (13%), or induced (77%). Estrogen treatment was initiated at 15.0 ± 1.9 yr of age in those with induced puberty.

Main Outcome Measure: The main outcome measure was multivariate analysis of AH after grouping potential predictors.

Results: The mean AH was 149.9 ± 6.1 cm, 8.5 cm above projected height. The model explained 90% of the variance, with major effects of age at initiation and duration of treatment. Other factors included birth length, target height, bone age delay and weight at initiation of treatment, age at pubertal onset, GH dose, and number of injections per week. Age at introduction of estrogens was not a predictor, and the use of percutaneous vs. oral estrogens was associated with greater height (+2.1 cm; 95% confidence interval, 1.00–3.25).

Conclusions: Our results support the early initiation of GH treatment and induction of puberty at a physiological age to achieve optimal AH. They suggest that GH should be injected daily, and percutaneous estrogens used. These results should be considered in the context of the lack of demonstrable influence of AH on psycho-social outcomes, uncertainties regarding long-term safety, and treatment cost.

This article has been cited by other articles:

				M. L. DAVENPORT Moving Toward an Understanding of Hormone Replacement Therapy in Adolescent Girls: Looking through the Lens of Turner Syndrome Ann. N.Y. Acad. Sci., June 1, 2008; 1135(1): 126 - 137. [Abstract] [Full Text] [PDF]

				M. L. Davenport, B. J. Crowe, S. H. Travers, K. Rubin, J. L. Ross, P. Y. Fechner, D. F. Gunther, C. Liu, M. E. Geffner, K. Thrailkill, et al. Growth Hormone Treatment of Early Growth Failure in Toddlers with Turner Syndrome: A Randomized, Controlled, Multicenter Trial J. Clin. Endocrinol. Metab., September 1, 2007; 92(9): 3406 - 3416. [Abstract] [Full Text] [PDF]

				J.-C. Carel, C. Elie, E. Ecosse, M. Tauber, J. Leger, S. Cabrol, M. Nicolino, R. Brauner, J.-L. Chaussain, and J. Coste Self-Esteem and Social Adjustment in Young Women with Turner Syndrome--Influence of Pubertal Management and Sexuality: Population-Based Cohort Study J. Clin. Endocrinol. Metab., August 1, 2006; 91(8): 2972 - 2979. [Abstract] [Full Text] [PDF]

				C. A. Bondy, P. L. Van, V. K. Bakalov, and V. B. Ho Growth Hormone Treatment and Aortic Dimensions in Turner Syndrome J. Clin. Endocrinol. Metab., May 1, 2006; 91(5): 1785 - 1788. [Abstract] [Full Text] [PDF]