Background: Early TS diagnosis permits early GH start and estradiol (E2) supplementation, approaching adult height (AH) at normal age and within normal range. However, higher age at diagnosis is still a challenge according to age for puberty induction and AH.
Objective and hypotheses: The objective from our long term trials is knowledge enough for personalized treatment in order to obtain a psychological acceptable age at onset of puberty and still an attained AH within normal range.
Method: Results from national multicenter studies with GH treatment (33/67 ug/kg per day) in combination with possible oxandrolone from 11 years and oral/transdermal estradiol will be presented: 132 prepubertal TS girls (39 or 916 years) were allocated into different treatment groups and followed until AH.
Results: HeightS.D.s at start was −2.8 (vs non-TS prepubertal reference) 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 for puberty onset and AH by using higher GH dose, oxandrolone and slow E2 dose increment, thus optimizing the treatment tools GH dose, oxandrolone and E2 in a personalized approach.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology