Growth and development in girls with Turner's syndrome during early therapy with low doses of estradiol

Abstract

Early therapy with a low dose of estrogen (estradiol-17.beta.) was given to 33 girls with Turner''s syndrome (T.s.) for a period of 4 years. The dose (0.25-2 mg/day) was adjusted every 3 months to maintain plasma estradiol in the normal concentration range for bone age. Growth velocity was compared with that of untreated girls with T.s. All girls were above age 10 years. Bone age was below 10 years in 11 girls (group I) and above 10 years in 22 girls (group II). Growth velocity in the first year of treatment in group I 7.5 .+-. 1.3 cm (SD) with mean SD score (SDS) of +4.3 and in group II 4.9 .+-. 1.3 with mean SDS of +3.5. Growth velocity decreased in the following years to 1.6 .+-. 1.0 cm, SDS -1.44 in group I and 0.9 .+-. 0.6 cm, SDS -2.34 in group II during the fourth year. Withdrawal bleeding occurred in 16 girls of group II after the mean of 23 (range 15-33) months and in 3 girls of group I after 15 to 51 months of treatment. The treatment did not cause an inappropriate acceleration of pubertal development. Breast development appeared in most girls by 3 months of treatment. Pubic hair appeared by 12 months of treatment in group I; it was present in most girls in group II at start of treatment. Final height is known for 12 girls of group II; it was 144.2 .+-. 4.5 cm. The final height as predicted at the start of therapy was 142.2 .+-. 5.3 cm. Bone age advanced in the first year of treatment by 2 years. Early treatment with small doses of estrogens induces a growth spurt and normalizes the events of puberty. This will presumably decrease the psychological risks associated with abnormally delayed development.