Background: The diagnosis of turner syndrome (TS) must be included in the differential diagnosis of all girls with short stature. Despite overall earlier diagnosis and treatment there still remain patients with TS who present late with delayed puberty. Although growth hormone (GH) is known to increase final height (FH) in girls with TS, little evidence exists on treatment in late-presenting girls.
Objective and hypotheses: To assess the effect of late GH treatment along with delayed pubertal induction on FH of girls with TS.
Method: Thirteen girls with TS presenting after 12 years of age were studied. Standard GH treatment was initiated immediately after diagnosis and 8/13 were also treated with the anabolic steroid oxandrolone. Oestrogen treatment was started at a mean of 1.75years (SD:0.77) after initiation of GH (minimum age 13 years). FH was calculated when the height velocity was ≤2 cm/year.
Results: Mean(SD) age was 14.37(1.7) years at GH start and 15.22(1.3) years at oestrogen replacement initiation. The mean(SD) FH-SDS using normal girls growth charts [−0.89(0.70)], as well as TS-specific charts [1.12(0.63)] was statistically significantly higher compared to presentation height SDS (normal female growth charts [−2.62(0.56)] and TS charts [2.28(0.77)]) both P<0.0001. The FH range was 151.2165 cm ie. within the normal range for girls without TS. There was no statistically significant difference in FH-SDS between those patients who received oxandrolone and those who did not.
Conclusion: We have shown that despite late GH treatment in girls with TS presenting with delayed puberty, a normal FH can be achieved. Previous studies have shown that late pubertal induction improves FH, as well as oxandrolone treatment, factors that seem to have had a positive effect in our patients.
10 Sep 2016 - 12 Sep 2016