Growth hormone in combination with anabolic steroids in patients with Turner syndrome: effect on bone maturation and final height.

Twenty patients with Turner syndrome (CA 7.3-16.4 years) were treated with growth hormone (GH) alone (12-18 IU/m2/week) for 0.9-2.5 years. Subsequently, all patients received GH 18 IU/m2/week in combination with oxandrolone (Ox) (0.0625 mg/kg/day po) or low dose testosterone (5 mg every 2 weeks, i.m.). Ethinylestradiol (50 ng/kg/day po) was started with a bone age of 12.5 "years", and the dose was increased stepwise to 200 ng/kg/day during the next 18 months. Final height (FH) after 4-7.7 years of therapy was 152.9 +/- 3.5 cm (range 145.0-158.9 cm). When compared to projected adult height (PAH) at start of therapy (143.7 +/- 4.0, range 137.5-151.0 cm), the estimated benefit from therapy (FH minus PAH) is 9.3 +/- 4.9 cm (range 1.4-21.4 cm). The wide range in individual responses may be due to over- or underestimation of PAH before therapy due to variable delay in bone age at start of therapy. FH did not differ between starting therapy before 11.5 years (n = 9; 152.0 +/- 3.4 cm) and after the age of 11.5 years (n = 11; 153.7 +/- 3.6 cm), due to the fact that a better short-term response to therapy in the younger group of patients was compensated for by a faster progression in bone age. The good result in terms of final height may be due in part to the late start (BA 13.3 +/- 0.4 years; range 12.7-14.5 years) of estrogen therapy in low doses.