Critical analysis of height reduction in oestrogen-treated tall girls

Evaluation and phenotypic characteristics of 293 Danish girls with tall stature: effects of oral administration of natural 17β-estradiol

BACKGROUND

Reduction of adult height by sex steroid treatment was introduced decades ago in tall statured children, but controlled trials are lacking and treatment is controversial. In this study, we wanted to evaluate the phenotypic characteristics in girls referred due to tall stature and the effect of oral administration of 17β-estradiol on predicted adult height in girls.

METHODS

A single-centre retrospective observational study of 304 girls evaluated consecutively due to tall stature between 1993 and 2013. 207 patients diagnosed with constitutionally tall stature (CTS), 60 (29%) girls ended up being treated with 17β-estradiol with a duration of 1.7 y (1.2; 2.5) (median (25; 75 percentile)), and final height was available in 26 girls.

RESULTS

At baseline, 20% of girls with CTS had supranormal IGF-I, whereas reproductive hormones were within the normal range. Final adult height was reduced with 1.6 ± 2.1 cm in the girls treated with 17β-estradiol when compared to initial prediction. Chronological age, bone age, estradiol, and IGF-I at baseline or estrogen dose did not predict height reduction.

CONCLUSIONS

Serum IGF-I was elevated tall statured children, but did not predict the effect of treatment with 17β-estradiol, which caused a modest reduction in final adult height.

Growth-reductive therapy in children with marfan syndrome

OBJECTIVES

To determine the accuracy and precision of 2 height-prediction methods in Marfan syndrome and to assess the growth-reductive effect and side effects of sex hormone treatment.

STUDY DESIGN

In a retrospective study in 31 untreated (17 boys) and 43 treated patients (21 boys) with Marfan syndrome, we assessed bone age and predicted adult height by 2 methods. The accuracy of the methods was assessed in the untreated group. The effect of therapy was corrected for outcome in the untreated group and other confounding variables with multivariate analysis.

RESULTS

Accuracy strongly varied with sex, chronological age, and prediction method. Overall precision was low. Treatment was started at a mean age of 12.8 +/- 1.4 years (boys) and 11.4 +/- 1.2 years (girls). With multiple regression analysis, a statistically significant effect was observed only in boys using a pharmacologic dosage (5.5 cm, 95% CI 0.96-10.1 cm; P = .02). Side effects were worsening of acne and weight and muscle gain.

CONCLUSIONS

In adolescents with Marfan syndrome, the accuracy and precision of 2 height-prediction methods were limited. The apparent growth-reductive effect of sex hormone treatment appears similar to earlier reports on adolescents with constitutional tall stature. There were no clinically important short-term side effects.

Impact of different doses of ethinyl oestradiol on reduction of final height in constitutionally tall girls

Fifty-two tall girls were treated for constitutionally tall stature with different ethinyl oestradiol (EE) dosages. They were divided into three different treatment groups: group B (100 micrograms EE/day; n = 11); group C (300 micrograms; n = 25) and group D (500 micrograms; n = 16) and compared with an untreated group A (n = 21) matched for age, height, bone age (BA) and height prediction. Using the height prediction method TW II, EE treatment reduced final height compared with the untreated girls in a weak dose-dependent manner, 2.3 cm (100 micrograms/day), 3.0 cm (300 micrograms/day), and 3.8 cm (500 micrograms/day). Such a dose dependency was not found on applying the Bayley-Pineau height prediction method (100 micrograms/day; 4.1 cm; 300 micrograms/day: 4.2 cm; 500 micrograms/day: 4.5 cm). However, there was a striking inverse correlation of the BA at the onset of treatment with the height reduction achieved using the TW II method (r: -0.43; P < 0.001). Importantly, girls with a BA below 12 years at the onset of treatment experienced a height reduction of more than 6 cm. CONCLUSION The EE dose used in the range of 100-500 micrograms/day is not crucial for the amount of height reduction in tall girls. In general high dose EE treatment should be given restrictively, and especially so in girls with a BA (TW2 RUS-ZH) above 12.0 years.

Adult height in constitutionally tall stature: accuracy of five different height prediction methods

The accuracy of height predictions at various ages based on five different methods (Tanner-Whitehouse mark I; Tanner-Whitehouse mark II; index of potential height; Bayley-Pinneau; Roche-Wainer-Thissen) was compared at yearly intervals with final height achieved in 32 boys (78 predictions) and 100 girls (227 predictions) with constitutionally tall stature. The boys were initially seen at a mean (SD) chronological age of 12.5 (3) years whereas the mean chronological age in girls was 11.8 (2.1) years. In tall boys Tanner-Whitehouse mark II gives a good estimation of final height up to the bone age of 13 years with a mean overestimation of 1 cm. The overestimation of final height is higher in the bone age groups 13-14 years (2.7 cm) and 14-15 years (3.4 cm) mainly due to the tall boys with a height greater than 3 SD scores. Up to the bone age of 12 years the final height is massively overestimated by the Bayley-Pinneau method but this method give relatively accurate estimations thereafter. The estimated confidence limits are large (+/- 8 cm) for the two methods up to a bone age of 15 years. In tall girls the Tanner-Whitehouse mark II method was accurate from bone age nine to 12 years but overestimated final height in the bone age groups 12-13 years and 13-15 years by a mean of 1.8 and 1.4 cm respectively. The Bayley-Pinneau method overestimated final height in the bone age groups 12-14 years whereas the height predictions are accurate thereafter. Up to a bone age of 13 years the estimated confidence limits for the two methods are large, +/- cm, but tend to improve thereafter. It is concluded that there is no best or most accurate method for predicting adult height in tall children. There are methods of first choice differing with respect to sex and bone age. In addition, correcting factors may improve their accuracy and correct their tendency to overestimate or underestimate adult height.

Psychological effects of sodium valproate and carbamazepine in epilepsy

Information from standardised tests of intelligence, school attainments, attention, memory and visuomotor function, together with parent and teacher questionnaire information about various aspects of behaviour, was obtained for 63 schoolchildren with newly diagnosed epilepsy before treatment with sodium valproate or carbamazepine, and again at intervals for a total period of 12 months. The same information was collected on 47 matched controls. The children with epilepsy represented those under non-specialised paediatric care. The result showed that both drugs were effective in most cases at modest dosage without causing notable psychological effects 12 months into treatment. Modest and temporary adverse cognitive effects seen earlier in treatment could have been the result of uncontrolled seizure discharge. Improved function was the same in children with epilepsy and controls. Some psychological abnormalities in the children with epilepsy were evident before treatment suggesting early unwanted effects of the epileptic process itself.

Oestrogen treatment of tall girls: effect decreases with age

Fifty-nine tall girls were treated with oestrogen to reduce final height, starting at the ages of 9.1 to 16.2 years. We assessed the result of this treatment by comparison with matched controls. The epiphyseal bone age at the start of therapy, the final height, the Bayley-Pinneau (BP) and Roche-Wainer-Thissen (RWT) predictions of final height, and the errors in both predictions were evaluated. The matched pairs were divided into three groups according to bone age at the start of treatment; I less than 10.5 (n = 16), II 10.5-12.0 (n = 22) and III greater than 12.0 years (n = 21). The mean (SD) intrapair reduction of height for these groups was 9.7 (4.0) cm, 4.3 (4.3) cm and 3.5 (3.2) cm, respectively, according to BP predictions and 6.3 (4.3) cm, 3.4 (3.0) cm and 1.2 (3.3) cm according to RWT predictions. No method of predicting height is accurate for tall girls and simultaneous predictions may differ greatly. Close agreement between the BP and RWT predictions does not indicate greater accuracy. The earlier therapy is started, the greater is the effect. Young girls need psychosocial support with therapy.

Cholinergic muscarinic blockade produces short-term suppression of growth hormone secretion in children with tall stature

We have studied the effects of oral pirenzepine (50 mg twice daily) on growth and growth hormone (GH) secretion in 10 children with tall stature (9F, 1M). Suppression of GH secretion was observed in all children for 2-3 h after drug administration but was followed by rebound secretion of GH after 4-6 h. Consequently there was little overall change in GH secretion. In the dose regimen used the disruption of normal pulsatile GH secretion was not sufficiently significant to change final or predicted heights.

Increase of serum lipids and serum lipoproteins in girls under therapy with estrogen and norethisteron for height reduction

The effect of a combined treatment with ethinyl estradiol and norethisteron for height reduction on serum lipids and lipoproteins was investigated in 23 excessively tall girls (greater than 97th percentile). Serum cholesterol, triglycerides, HDL-C and LDL-C were determined before and 3, 6, 9 and 12 months after the onset and 3 to 12 months after cessation of therapy. Treatment with ethinyl estradiol and norethisteron resulted in significant (p less than 0.01) mean increases in serum cholesterol, triglycerides, HDL-C, and LDL-C of 20.6%, 95.5%, 23.6%, and 22.2% above pretreatment values, respectively. This increase occurred during the first 3 months of therapy and thereafter no further significant change was observed. After cessation of therapy elevated levels returned to pretreatment levels within 3 to 12 months in all but two patients. The results obtained suggest an influence of ethinyl estradiol and norethisteron on serum lipids and lipoproteins. Whether these reversible changes of serum lipids and lipoproteins are associated with an increased risk for developing atherosclerosis has to be evaluated in long term investigations.