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Low-dose estrogen plus GH may optimize outcomes in patients with Turner Syndrome

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The Endocrine Society's 90th Annual Meeting

Girls with Turner Syndrome may benefit from childhood low-dose estrogen plus growth hormone.

“Our study demonstrated a synergistic effect between low-dose estrogen and growth hormone in improving adult height,” Judith L. Ross, MD, Department of Pediatrics at Thomas Jefferson University in Philadelphia, said during her presentation yesterday at the Endocrine Society’s 90^th Annual Meeting in San Francisco.

Ross and colleagues conducted a double-blind, randomized, placebo-controlled trial in 149 girls with Turner Syndrome aged five to 12.5 years to determine the effects of childhood low-dose estrogen on pubertal development.

Patients were assigned to one of four treatment arms: placebo and placebo (n=39), GH plus placebo (n=35), placebo plus estrogen (n=40) and GH plus estrogen (n=35). Those aged five to 12.5 years were assigned to ethinyl estradiol 25 ng/kg/d and those aged eight to 12 years to 50 ng/kg/d. At age 12, all patients were assigned to estrogen replacement.

“The duration of Tanner 2 to menarche was actually shorter in the placebo group. The placebo group was older at Tanner 2, but the same age as the estrogen-treated group at menarche, therefore they had a faster tempo of puberty than the estrogen group,” Ross said.

The researchers reported a dose-dependent dissociation of ethinyl estrogen (EE2) mediated maturation. Breast development was stimulated by low-dose estrogen, though bone and uterine maturation were not.

“This regimen may have important psychosocial and cognitive implications. Consideration should be given to physiologic individualized estrogen replacement during childhood in girls with Turner Syndrome,” Ross said. – by Stacey L. Adams

For more information:

• Ross JL. Effects of childhood low-dose estrogen on pubertal development in patients with Turner Syndrome: results of a double-blind, randomized, placebo-controlled clinical trial. Presented at: The Endocrine Society’s 90th Annual Meeting; June 15-18; San Francisco.