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Early GH treatment produced greater height increases in girls with Turner syndrome

No increased safety risk found with early GH initiation.

Issue: November 2007

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Early initiation of growth hormone therapy corrected growth failure in young girls when therapy was started before age 4 years, according to a study by Marsha L. Davenport, MD, and colleagues.

The prospective, randomized controlled trial assessed the effects of early-initiated GH in 88 girls aged 9 months to 4 years with Turner syndrome. Girls who received early GH treatment (50 mcg/kg per day; n=45) had significant increases in height after two years compared with girls who received no treatment (n=43).

Changes in height

Each girl demonstrated growth failure at baseline. After two years, height SDS increased from –1.4 to –0.3 in girls who received GH therapy. Those who received no treatment experienced a progressive decline, characteristic of Turner syndrome (–1.8 to –2.2).

The researchers calculated a two-year between-group difference of 1.6 ± 0.6 (P<.0001). Additionally, there were no unexpected safety signals associated with early-initiation of GH therapy in the girls. – by Katie Kalvaitis

Editor’s note: This is an important study, but this is only one approach. There are alternative approaches and there is a price to pay for early treatment. The issue is how does one weigh the benefits of early vs. later treatment? This study talks about giving young children daily shots, at a time when most are still within the normal growth curve. An alternative approach is to defer therapy until the child falls below some arbitrary point (eg, –1.5 or –2.0 SD). While it is possible (although still unproven) that a patient might gain additional adult height by beginning treatment at the earliest possible age, to me, the gain does not really justify that early initiation of therapy in every Turner syndrome child. I have been quite successful with the approach of following a guideline and waiting until the patient falls below –2 SD to initiate therapy. Still, this study does not nicely demonstrate the feasibility of early therapy in Turner syndrome. Perhaps, as is often the case, the “best” approach is to individualize therapy for each child.
– Ron Rosenfeld, MD, Senior Vice-President for Medical Affairs, Lucile Packard Foundation for Children’s Health.

• Davenport ML, Crowe BJ, Travers SH, et al. Growth hormone treatment of early growth failure in toddlers with Turner syndrome: a randomized, controlled, multicenter trial. J Clin Endocrinol Metab. 2007;92:3406-3416.