ESPE Abstracts

Background: Tall stature may be associated with psychological distress in some girls, and height reduction by oestrogen therapy has been described, but remains controversial. Possible side effects of ethinyl oestradiol therapy need to be balanced against a possible beneficial effect on adult height. In our centre natural 17-β oestradiol, which has a better safety profile, is used to reduce final height.

Objective and hypotheses: To evaluate the phenotypic characteristics in a large cohort of 304 girls referred due to tall stature, and to evaluate the effect of oral 17-β Estradiol (E2) on final height.

Method: A retrospective observational study of 304 tall statured girls referred between 1993 and 2013 in a single tertiary centre. We included 207 girls whom fulfilled the criteria height >2 S.D., after exclusions due to misclassification and overgrowth syndromes. Of these girls, 60 were treated with E2 for an average duration of 1.7 years (1.2–2.5) and 26 were followed until final height. Auxology, adult height prediction (AHP), reproductive hormones and attained final height were evaluated.

Results: Chronological age and bone age were 11.6 years (7.95–13.4) and 11.8 years (8.9–13.3) respectively. Bone age delay at referral was significantly greater in the treated girls (0.26 years (−0.66–1.33)) compared to non-treated girls (−0.41 years (−1.2–0.23)), P<0.05. At referral, maternal height was higher in treated girls (P<0.05) but there were no significant differences in Height S.D.s, AHP, FSH, LH, E2 and IGF1 levels. Final height was reduced in 18/26 girls, from an average AHP of 184.5 cm (183.4–186.7) at baseline to 183.3 cm (181.7–186.3), P<0.05, n=26. CA, BA and IGF1 at baseline did not predict E2-induced height reduction.

Conclusion: Treatment of constitutional tall stature (CTS) with 17-β oestradiol has moderate growth reducing effects, and cannot be recommended in general but should be reserved for selected cases.