Growth in turner syndrome

Although the pathogenesis of growth failure in Turner syndrome remains uncertain, recent clinical trials with human growth hormone (hGH), androgens, and estrogens permit us to make several observations regarding effective growth-promoting therapy. Treatment with hGH alone provides a modest, but significant, increase in growth velocity for Turner patients, an effect that can be best appreciated when results are compared with the natural history of untreated Turner girls. Growth hormone, alone and in combination with oxandrolone, also appears to have a favorable effect upon final height. In on-going studies using recombinant hGH, over 75% of subjects have already exceeded their projected adult height, and an adult height over 150 cm appears to be a reasonable goal for most girls with Turner syndrome. Although the addition of low-dose oxandrolone to hGH further increases growth velocity, it is still too early to determine whether hGH alone or combination therapy will result in the better final height. Therefore, the role for oxandrolone in routine management of Turner syndrome remains to be determined. Estrogen does not appear to have a role in growth therapy, but the growth response to hGH theoretically allows for earlier addition of low-dose estrogen for feminization. Lastly, we recommend that hGH therapy begin as soon as significant growth deceleration occurs: not only is the beneficial effect on final adult height potentially greater, but girls with Turner syndrome can also receive the psychological benefit of remaining close to the normal growth curve during childhood.