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Submitted on March 3, 2005
Accepted on June 28, 2005
Department of Pediatric Endocrinology and INSERM U561, Groupe hospitalier Cochin - Saint Vincent de Paul and Université Paris V, Paris, France; Department of Biostatistics, Groupe hospitalier Cochin - Saint Vincent de Paul and Université Paris V, Paris, France; Department of Pediatric Endocrinology, Hôpital Robert Debré, Paris, France; Department of Pediatric Endocrinology, Hôpital des Enfants, Toulouse, France; Department of Pediatric Endocrinology, Hôpital Armand Trousseau, Paris, France; Department of Pediatric Endocrinology, Hôpital Debrousse, Lyon, France; Department of Pediatric Endocrinology, Hôpital de Bicêtre, Le Kremlin Bicêtre, France; The list of investigators is included in the acknowledgments section
* To whom correspondence should be addressed. E-mail: carel{at}paris5.inserm.fr.
Objective. To evaluate factors affecting adult height (AH) in patients with Turner syndrome treated with growth hormone (GH).
Design. Population-based cohort study.
Setting. The StaTur study: 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) (M ± SD) 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. Multivariate analysis of AH, after grouping potential predictors.
Results. Mean AH was 149.9 ± 6.1 cm, 8.5 cm above projected height. The model explained 90% of 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, growth hormone 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%CI 1.00 to 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.
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