Height enhancement in Turner syndrome: Is it clinically significant?

The successful treatment of girls with Turner syndrome (TS) with growth hormone (GH) is now regarded as standard practice, but is the benefit of treating these children truly clinically significant? Dr. Ron Rosenfeld, a pediatric endocrinologist, was assigned the "pro" position for this debate. He presents evidence that GH accelerates growth and improves final height in TS, that this outcome can be achieved without excessive delay in pubertal development, and that GH is safe for these patients. Anecdotal experience suggests a beneficial effect of GH therapy on quality of life in children and young adults with TS, but studies assessing effect of growth-promoting therapy on psychosocial function are lacking. Conclusive data will be extremely difficult, if not impossible, to obtain in the current environment. Dr. Harvey Guyda, also a pediatric endocrinologist, was assigned the "con" position. He argues that the desired outcome for most patients (therefore, achieving a "normal" height) does not occur for the majority of girls with TS treated with GH. The median final height achieved by patients in the Canadian randomized controlled study is only -2.3 height SD score. Although some individuals have shown dramatic responses, only ∼50% of those in the Canadian study can expect a height benefit >5 cm. Further, Guyda emphasizes that treatment has not been proven to lead to improved psychosocial functioning. A challenge remains to determine methods to identify the TS patients who are most likely to benefit from prolonged GH prescriptions.