European Journal of Pediatrics

, Volume 153, Issue 2, pp 72–77 | Cite as

Growth hormone and 17β-oestradiol treatment of Turner girls — 2-year results

  • Rune W. Naeraa
  • Johannes Nielsen
  • Knud W. Kastrup
Endocrinology Original Paper


Girls with Turner syndrome are mainly characterized by growth retardation and gonadal insufficiency. In order to evaluate the effect of growth hormone (GH) and/or low dose 17β-oestradiol (E2) on growth and pubertal development, 39 Turner girls with a chronological age (CA) of 7.6–18.1 years were divided into three groups depending on pretreatment bone age (BA). They were treated with either GH 0.1 IE/kg per day (n=13, BA 7.1–10.2), peroral E2 0.01 mg/kg per day (n=8, BA 8.5–12.7) or both (n=18, BA 10.5–15.3). In the 2nd year the E2 group also received GH, while the E2 dose was reduced 30%. In the 1st year height velocity (HV) expressed as standard deviation scores (SDS) increased in all groups (mean): from −0.4 to 3.3 (P<0.01) in the GH group, −0.5 to 2.7 (P<0.01) in the E2 group, and −0.8 to 4.6 (P<0.001) in the GH +E2 group. A possible synergistic effect from combination therapy was seen, as HV increase was higher in group 3 than groups 1 and 2 (P<0.05). In the 2nd year HV was unchanged in groups 1 and 2, while a clear decrease was seen in the GH+E2 group (P<0.001). In the 1st year BA progression in the E2 group was rapid (1.9 BA/CA year) and higher than in the other groups (P<0.05). In the 2nd year progression slowed down-particularly in the E2 group (0.7 BA/CA year,P=0.07). Predicted final height (PFH) increased gradually over the 2 years in the GH group up to 4.1 cm (P<0.01), while in the GH+E2 group PFH increased 2.6 cm (P=0.001) after 1 year, but progressed no further during the 2nd year. In the E2 group PFH decreased −3.1 cm (P=0.055) during the 1st year, while in the 2nd year PFH returned to pretreatment levels. Insulin-like growth factor (IGF-I) increased during the 1st year in the GH and the GH+E2 groups (P<0.01 andP<0.05), while it was unchanged in the E2 group (P>0.4). Except for some of the youngest and oldest girls, breast development was appropriate. No major side-effects were noted. In one girl growth of naevi was noted, but they disappeared spontaneously within 3 months. We conclude that GH and peroral E2 both stimulate HV and appear to have a synergistic effect. The effect of peroral E2 is not mediated by increasing IGF-I. When BA is below 11 years, E2 leads to an accelerated BA maturation, which potentially decreases final height. An initial dose lower than 10 μg E2/kg per day and a minimum BA of 11 years are recommended to initiate treatment.

Key words

Turner syndrome Growth stimulation Oestradiol Growth hormone IGF-I 



bone age


chronological age






human growth hormone


height velocity


insulin-like growth factor


predicted final height


standard deviation scores


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Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • Rune W. Naeraa
    • 1
  • Johannes Nielsen
    • 2
    • 3
  • Knud W. Kastrup
    • 4
  1. 1.Department of Internal Medicine M (Endocrinology and Diabetes), KommunehospitaletAarhus University HospitalAarhusDenmark
  2. 2.The Turner Centre, Aarhus Psychiatric HospitalAarhus University HospitalRisskovDenmark
  3. 3.Cytogenetic Laboratory, Aarhus Psychiatric HospitalAarhus University HospitalRisskovDenmark
  4. 4.Department of PaediatricsCopenhagen County HospitalGlostrupDenmark

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