NEAR NORMALIZATION OF FINAL HEIGHT WITH ADAPTED DOSES OF GROWTH-HORMONE IN TURNERS-SYNDROME

An adapted GH dose regimen was evaluated in 14 untreated patients with Turner's syndrome. The initial GH dose (0.7 U/kg.BW) was increased by 0.7 U/kg.BW, up to a maximum of 2.1 U/kg.BW, when growth velocity (GV ) declined to less than 200% of the pretreatment level. These patients were compared to a group of 17 patients with similar initial characte ristics, who received a fixed dose of 0.9 U/kg.BW GH. Tolerance to bot h GH regimens was excellent. The adapted GH doses only partially preve nted the waning effect observed with conventional doses of GH, and the initial goal of doubling GV was only achieved in 42% of the 112 patie nt-semesters. Doubling the GH dose from 0.7 to 1.4 U/kg.BW increased t he GV by 1.6 +/- 1.8 cm/yr (P < 0.006); increasing the GH dose from 1. 4 to 2.1 U/kg.BW increased GV by 0.8 +/- 1.3 cm/yr (P = NS). The overa ll height gain during the 4-yr trial was 25.6 +/- 3.9 cm in the adapte d dose group and 21.8 +/- 3.9 cm in the conventional group (P < 0.02). Final height (FH) results were obtained in 12 of 14 patients in the a dapted dose group and all 17 patients in the conventional group and co mpared to the predicted FH using Lyon's method. The estimated height b enefit was 10.6 +/- 3.8 cm in the adapted dose group compared to 5.2 /- 3.7 cm in the conventional group (P < 0.01). Eighty-three percent o f the patients in the adapted dose group had an FH superior or equal t o -2 so score for the general population compared to 29% in the conven tional group. In conclusion, a marked increment in the GH dose in girl s with Turner's syndrome associated with a relatively late age at intr oduction of estrogen therapy brought 83% of the patients into the lowe r range of the normal height distribution of the general population.