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Related Experiment Videos

Optimizing estrogen replacement treatment in Turner syndrome

R L Rosenfield1, N Perovic, N Devine

  • 1Department of Pediatrics, University of Chicago, Chicago, Illinois 60637-1470, USA.

Pediatrics
|August 1, 1998
PubMed
Summary

Low-dose systemic estradiol therapy, when combined with growth hormone (GH) for girls with Turner syndrome (TS), significantly boosts final height. This approach optimizes estrogen replacement for improved growth outcomes in TS patients.

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Area of Science:

  • Pediatric Endocrinology
  • Growth Hormone Therapy
  • Hormone Replacement Therapy

Background:

  • Estrogen exhibits a biphasic effect on growth: stimulatory at low doses and inhibitory at high doses.
  • Optimal sex hormone replacement in girls with Turner syndrome (TS) requires careful consideration of estrogen dose, form, route, and timing, especially when co-administered with growth hormone (GH).

Purpose of the Study:

  • To evaluate the efficacy of a low-dose, systemically administered estradiol regimen for enhancing final height in girls with Turner syndrome (TS) undergoing growth hormone (GH) therapy.

Main Methods:

  • A preliminary analysis involved 9 girls with TS treated with GH for ≥6 months.
  • Depot estradiol was administered monthly intramuscularly, starting at 0.2 mg and escalating to 0.8 mg over time.
  • Results were compared to a matched group of 37 TS patients receiving routine estrogen treatment alongside GH therapy.

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Main Results:

  • Patients treated with depot estradiol showed a 2.6 cm greater height gain over 2 years compared to those on routine estrogen.
  • Bone age progression in the depot estradiol group was proportional to chronological age, indicating a potential increase in predicted adult height.

Conclusions:

  • Very low doses of systemic estradiol, used to induce puberty before age 15 in girls with TS on GH therapy, can lead to increased final heights.
  • This optimized estrogen replacement strategy offers a promising alternative to routine estrogen therapy for improving growth outcomes in Turner syndrome.