Gradually increasing ethinyl estradiol for Turner syndrome may produce good final height but not ideal BMD

• Published in: Endocrine Journal Vol. 64; no. 2; pp. 221 - 227
• Main Authors: Igaki-Miyamoto, Junko, Hasegawa, Yukihiro, Hatano, Megumi, Ariyasu, Daisuke, Yagi, Hiroko, Fukuma, Mami, Izawa, Masako, Goto, Masahiro
• Format: Journal Article
• Language: English
• Published: Japan The Japan Endocrine Society 01.01.2017
• Subjects: Adolescent; BMD (bone mineral density); Body Height - drug effects; Bone Density - drug effects; Child; Child, Preschool; Cohort Studies; Dose-Response Relationship, Drug; Estrogen Replacement Therapy - methods; Ethinyl estradiol; Ethinyl Estradiol - administration & dosage; Ethinyl Estradiol - adverse effects; Female; Final height; Follow-Up Studies; Human Growth Hormone - therapeutic use; Humans; Infant; Japan; Menarche - drug effects; Turner syndrome; Turner Syndrome - drug therapy
• ISSN: 0918-8959; 1348-4540; 1348-4540
• DOI: 10.1507/endocrj.EJ16-0170

Estrogen replacement therapy in Turner syndrome should theoretically mimic the physiology of healthy girls. The objective of this study was to describe final height and bone mineral density (BMD) in a group of 17 Turner syndrome patients (group E) who started their ethinyl estradiol therapy with an ultra-low dosage (1-5 ng/kg/day) from 9.8-13.7 years. The subjects in group E had been treated with GH 0.35 mg/kg/week since the average age of 7.4 years. The 30 subjects in group L, one of the historical groups, were given comparable doses of GH, and conjugated estrogen 0.3125 mg/week ∼0.3125 mg/day was initiated at 12.2-18.7 years. The subjects in group S, the other historical group, were 21 patients who experienced breast development and menarche spontaneously. Final height (height gain < 2 cm/year) in group E was 152.4 ± 3.4 cm and the standard deviation (SD) was 2.02 ± 0.62 for Turner syndrome. The final height in group L was 148.5 ± 3.0 cm with a SD of 1.30 ± 0.55, which was significantly different from the values for group E. The volumetric BMD of group S (0.290 ± 0.026 g/cm3) was significantly different from that of group L or E (0.262 or 0.262 g/cm3 as a mean, respectively). This is the first study of patients with Turner syndrome where estrogen was administered initially in an ultra-low dose and then increased gradually. Our estrogen therapy in group E produced good final height but not ideal BMD.