ESPE Abstracts (2015) 84 P-1-137

Normalization of Puberty and Adult Height in Girls with Turner Syndrome, Randomised Trials vs Age and Dose at GH-Start

Berit Kriströma, Carina Ankarberg-Lindgrenb, Marie-Louise Barrenäsb, Karlolof Nilssonc & Kerstin Albertsson-Wiklandd


aInstitute of Clinical Science, Peadiatrics, Umeå University, Umeå, Sweden; bDepartment of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Göteborg Pediatric Growth Research Center, Göteborg, Sweden; cDepartment of Clinical Sciences, University Hospital Malmö, Lund University, Malmö, Sweden; dDepartment of Physiology/Endocrinology, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden


Background: Early TS diagnosis permits early GH start and estradiol (E2) supplementation approaching adult height (AH) at normal age and within a normal range. However, higher age at diagnosis is still a challenge.

Objective and hypotheses: The hypothesis from our long-term trials will result in knowledge for personalized treatment in order to obtain a psychological acceptable age at onset of puberty and still an attained AH within normal range for TS girls.

Method: 132 prepubertal TS girls (3–9/9–16 years) were randomised into national multicenter studies with GH treatment (33/67 μg/kg per day) in combination with possible oxandrolone from 11 years and oral/transdermal estradiol. Subjects were followed until AH.

Results: HeightSDS at start was -2.8 (vs non-TS) in all subgroups. Age at onset of puberty (years) and AH (cm) was for GH33young 14.7, 153.7; GH67young 13.0, 157.2; GH33old 15.2, 156.5; GH67old 14.1, 159.9. Oxandrolone was used in 94% of GH33 and in 54% of the GH67 group. Pubertal growth was 3.3, 7.7, 7.2 and 9.2 cm, respectively. In multivariate analysis the factors GH dose, age and duration of puberty(+) all had high impact on AH.

Conclusion: Younger age at start with higher GH dose results in increased prepubertal height gain, permitting puberty at normal age (2 years before low dose) and an AH within normal range. The girl diagnosed at higher age can still attain an acceptable age at puberty onset and AH – by using higher GH dose, oxandrolone and slow oestradiol dose increment. Thus it is now possible to optimise the treatment tools GH dose, oxandrolone and estradiol in a personalised approach.

Conflict of interest: BK has received lecture fee from Sandoz, Pfizer and Novo Nordisk.

Funding information: Growth hormone was partly provided (higher than standard dose) by Pharmacia/Pfizer.

Figure 1 Average Height over Time, by GH Start Age and Dose.

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