Effect of growth hormone and oxandrolone singly and together on growth rate in girls with X chromosome abnormalities

Human Growth and Growth Hormone: From Antiquity to the Recominant Age to the Future

Since antiquity Man has been fascinated by the variations in human (and animal) growth. Stories and art abound about giants and little people. Modern genetics have solved some of etiologies at both extremes of growth. Serious study began with the pathophysiology of acromegaly followed by early attempts at treatment culminating in modern endoscopic surgery and multiple pharmacologic agents. Virtually at the same time experiments with the removal of the pituitary from laboratory animals noted the slowing or stopping of linear growth and then over a few decades the extraction and purification of a protein within the anterior pituitary that restored, partially or in full, the animal's growth. Human growth hormone was purified decades after those from large animals and it was noted that it was species specific, that is, only primate growth hormone was metabolically active in primates. That was quite unlike the beef and pork insulins which revolutionized the care of children with diabetes mellitus. A number of studies included mild enzymatic digestion of beef growth hormone to determine if those "cores" had biologic activity in primates and man. Tantalizing data showed minimal but variable metabolic efficacy leading to the "active core" hypothesis, for these smaller peptides would be amenable to peptide synthesis in the time before recombinant DNA. Recombinant DNA changed the landscape remarkably promising nearly unlimited quantities of metabolically active hormone. Eight indications for therapeutic use have been approved by the Food and Drug Administration and a large number of clinical trials have been undertaken in multiple other conditions for which short stature in childhood is a sign. The future predicts other clinical indications for growth hormone therapy (and perhaps other components of the GH?IGF-1 axis), longer-acting analogues and perhaps a more physiologic method of administration as virtually all methods at present are far from physiologic.

Effect of oxandrolone therapy on adult height in Turner syndrome patients treated with growth hormone: a meta-analysis

Turner syndrome is a chromosomal abnormality in which there is complete or partial absence of the X chromosome. Turner syndrome effects 1 in every 2000 live births. Short stature is a cardinal feature of Turner Syndrome and the standard treatment is recombinant human growth hormone. When growth hormone is started at an early age a normal adult height can be achieved. With delayed diagnosis young women with Turner Syndrome may not reach a normal height. Adjuvant therapy with oxandrolone is used but there is no consensus on the optimal timing of treatment, the duration of treatment and the long term adverse effects of treatment. The objective of this review and meta-analysis is to examine the effect of oxandrolone on adult height in growth hormone treated Turner syndrome patients. Eligible trials were identified by a literature search using the terms: Turner syndrome, oxandrolone. The search was limited to English language randomized-controlled trials after 1980. Twenty-six articles were reviewed and four were included in the meta-analysis. A random effects model was used to calculate an effect size and confidence interval. The pooled effect size of 2.0759 (95 % CI 0.0988 to 4.0529) indicates that oxandrolone has a positive effect on adult height in Turner syndrome when combined with growth hormone therapy. In conclusion, the addition of oxandrolone to growth hormone therapy for treatment of short stature in Turner syndrome improves adult height. Further studies are warranted to investigate if there is a subset of Turner syndrome patients that would benefit most from growth hormone plus oxandrolone therapy, and to determine the optimal timing and duration of such therapy.

Comparative metabolomics of muscle interstitium fluid in human trapezius myalgia: an in vivo microdialysis study

Purpose

The mechanisms behind trapezius myalgia are unclear. Many hypotheses have been presented suggesting an altered metabolism in the muscle. Here, muscle microdialysate from healthy and myalgic muscle is analysed using metabolomics. Metabolomics analyse a vast number of metabolites, enabling a comprehensive explorative screening of the cellular processes in the muscle.

Methods

Microdialysate samples were obtained from the shoulder muscle of healthy and myalgic subjects that performed a work and stress test. Samples from the baseline period and from the recovery period were analysed using gas chromatography—mass spectrometry (GC–MS) together with multivariate analysis to detect differences in extracellular content of metabolites between groups. Systematic differences in metabolites between groups were identified using multivariate analysis and orthogonal partial least square discriminate analysis (OPLS-DA). A complementary Mann–Whitney U test of group difference in individual metabolites was also performed.

Results

A large number of metabolites were detected and identified in this screening study. At baseline, no systematic differences between groups were observed according to the OPLS-DA. However, two metabolites, l-leucine and pyroglutamic acid, were significantly more abundant in the myalgic muscle compared to the healthy muscle. In the recovery period, systematic difference in metabolites between the groups was observed according to the OPLS-DA. The groups differed in amino acids, fatty acids and carbohydrates. Myristic acid and putrescine were significantly more abundant and beta-d-glucopyranose was significantly less abundant in the myalgic muscle.

Conclusion

This study provides important information regarding the metabolite content, thereby presenting new clues regarding the pathophysiology of the myalgic muscle.

Effects of treatment with oxandrolone for 4 years on the frequency of severe arithmetic learning disability in girls with Turner syndrome

OBJECTIVES

To study androgen treatment effects on arithmetic performance in girls with Turner syndrome.

STUDY DESIGN

Forty-four girls, ages 10 to 14 years at baseline, completed 4 years of treatment with oxandrolone (Ox) or placebo (Pl). All received growth hormone and estrogen replacement therapy. We assessed the number of girls with severe learning disability (LD, standard score <or=5(th) percentile) on measures of academic arithmetic and reading achievement (WRAT-3, arithmetic and reading), given yearly, and the WIAT numerical operations (NOS) and reading subtests, given at year 4.

RESULTS

On the WRAT-3 arithmetic, the frequency of severe arithmetic LD was similar in the Ox and Pl groups at baseline and at years 1 and 2. At years 3 and 4, fewer girls in the Ox than Pl group had a severe arithmetic LD (year 4: 0/22 vs 5/21, P = .02). On the WIAT NOS (year 4), fewer girls in the Ox than Pl groups had a severe arithmetic LD (3/21 vs 8/20, P = .09). WIAT NOS error analysis suggested that the improved performance in the Ox group was associated with better performance on multiplication and division (P < .01). The frequency of severe LD for the WRAT-3 reading was similar for the Ox and Pl groups (all years) and for the WIAT reading subtest (year 4).

CONCLUSIONS

Androgen treatment for 4 years in girls with Turner syndrome resulted in a small decrease in frequency of severe arithmetic LD, with no effect on reading LD.

Influence of X chromosome and hormones on human brain development: a magnetic resonance imaging and proton magnetic resonance spectroscopy study of Turner syndrome

BACKGROUND

Women with Turner syndrome (TS; 45,X) lack a normal second X chromosome, and many are prescribed exogenous sex and growth hormones (GH). Hence, they allow us an opportunity to investigate genetic and endocrine influences on brain development.

METHODS

We examined brain anatomy and metabolism in 27 adult monosomic TS women and 21 control subjects with volumetric magnetic resonance imaging and magnetic resonance spectroscopy.

RESULTS

In TS women, regional gray matter volume was significantly smaller in parieto-occipital cortex and caudate nucleus and larger in cerebellar hemispheres. White matter was reduced in the cerebellar hemispheres, parieto-occipital regions, and splenium of the corpus callosum but was increased in the temporal and orbitofrontal lobes and genui of corpus callosum. Women with TS had a significantly lower parietal lobe concentration of N-acetyl aspartate, and higher hippocampal choline. Also, among women with TS, there were significant differences in regional gray matter volumes and/or neuronal integrity, depending upon parental origin of X chromosome and oxandrolone and GH use.

CONCLUSIONS

X chromosome monosomy, imprinting and neuroendocrine milieu modulate human brain development-perhaps in a regionally specific manner.

Long-term outcome of growth hormone therapy in children and adolescents

Growth hormone (GH) has been available for more than 4 decades for the treatment of GH deficiency. Initially, GH was extracted from the pituitary glands of human cadavers, but its use was discontinued following the transmission of the Creutzfeldt-Jakob virus. After the development of recombinant GH (somatropin) in 1985, an 'unlimited' commercial source of GH has been available, allowing for the treatment of a large number of short GH-deficient and -sufficient children. Refinements in both the dosage and the frequency of administration of GH have allowed GH-deficient children to reach nearly normal final heights, although mostly they are still below their target heights. Decreased bone mineral densities and increased concentrations of fasting and postprandial lipids, coagulation factors, and several independent cardiovascular risk factors have been reported in GH-deficient children and adolescents and appear to improve with GH administration. The short-term administration of GH to mostly non-GH-deficient short children with Turner syndrome, chronic renal insufficiency (CRI), intrauterine growth retardation (IUGR), and idiopathic short stature (ISS) has resulted in increased growth velocities. In addition, the final height of patients with Turner syndrome and CRI appears to improve with the long-term administration of GH. Final height data are still lacking in adolescents with IUGR, but height standard deviation score and final height predictions appear to improve with therapy. Based on the incomplete and inconclusive available data, one must conclude that GH treatment of children with ISS cannot be advised. The use of GH at replacement doses in children with GH deficiency has resulted in rare and generally reversible adverse effects. The long-term administration of pharmacologic GH doses to short, mostly non-GH-deficient children must, however, still be viewed with caution, as long-term complications cannot as yet be fully evaluated. GH therapy must be individualized and should be limited only to children with severe short stature or a significantly decreased growth velocity, to children under considerable stress due to their short stature, and to patients in whom low GH or low insulin-like growth factor-1 secretion might be the rate-limiting factors for growth. The cost of the medication and the inconvenience of daily GH injections to otherwise mostly healthy short children must also be taken into account.

Treatment of patients with Ullrich-Turner syndrome with conventional doses of growth hormone and the combination with testosterone or oxandrolone: effect on growth, IGF-I and IGFBP-3 concentrations

Thirty-nine girls with Ullrich-Turner syndrome (UTS) (median age 9.5 years) were treated with growth hormone (GH) with either 12 or 18 IU/m2 per week for 12 months followed by combination therapy with either oxandrolone (Ox) (0.0625 mg/kg/day po) or low-dose testosterone (T) (5 mg in every 2 weeks). Growth velocity improved significantly after 12 IU/m2 per week (6.4 +/- 1.7 cm/year vs 4.0 +/- 1.3 cm/year, x +/- SD, P < 0.001) and 18 IU/m2 per week of GH (6.5 +/- 1.3 cm/year vs 4.5 +/- 1.4 cm/year, P < 0.001). Ox, but not T was effective in maintaining growth velocity during the 2nd year of therapy (6.9 +/- 1.3 vs 5.3 +/- 1.5 cm/year). Basal insulin-like growth factor-I (IGF-I) concentrations were in the lower normal range and increased significantly in patients treated with 18 IU/m2 per week (357 +/- 180 ng/ml vs 160 +/- 84 ng/ml) and 12 IU/m2 per week (273 +/- 121 ng/ml vs 140 +/- 77 ng/ml). IGF-I concentrations increased further after addition of Ox (533 +/- 124 ng/ml, P < 0.001) or T (458 +/- 158, P < 0.05). IGFBP-3 concentrations were in the upper normal range before therapy and increased only moderately in both GH dosage groups. However, IGF binding protein-3 (IGFBP-3) concentrations were not affected by additional Ox or T treatment.

CONCLUSIONS

1. Conventional GH doses are effective in increasing growth velocity in UTS, especially, when combined with Ox.(ABSTRACT TRUNCATED AT 250 WORDS)

Change in speaking fundamental frequency in hormone-treated patients with Turner's syndrome--a longitudinal study of four cases

Change in speaking fundamental frequency for four hormone-treated girls with Turner's syndrome was registered using two computerized analysis methods for a period of four years. The girls were treated with human growth hormone, oxandrolone and ethinyl estradiol. The overall pattern for three of the girls was a distinct decline in speaking fundamental frequency during the first year, while for the fourth patient the pattern of change was more complicated. For all four girls, the final pitch level was within the normal range for adult women. It is important that voice effects are taken into account in the hormonal treatment of Turner's syndrome and that patients are informed of the changes to be expected.

Calcium and protein kinetics in prepubertal boys. Positive effects of testosterone

We investigated the effects of 4-6-wk administration of testosterone on calcium and protein metabolism in six healthy prepubertal short boys (mean age +/- SE = 12.9 +/- 0.6 yr). At baseline, subjects received a 4-h infusion of L-[1-13C]leucine and L-[2-15N]glutamine, and were given 42Ca intravenously, and 44Ca PO. Testosterone enanthate (approximately 3 mg/kg) was given I.M. 2 wk apart (two doses n = 5, three doses n = 1), and the study was repeated 4-5 d after the last injection. After testosterone therapy, there were significant increases in serum testosterone and mean peak and total growth hormone concentrations. Net calcium absorption (Va) and retention (Vbal) also increased (Va 13.3 +/- 2.3 vs 21.5 +/- 2.3; mg.kg-1.d-1, Vbal 8.0 +/- 2.1 vs 16.6 +/- 2.5, mg.kg-1.d-1, P < .05 both), as well as Ca's net forward flow into bone and total exchangeable pool (16 and 20%, respectively). The rate of appearance of leucine (an indicator of proteolysis) increased by 17.6 +/- 5.9%, P = 0.036. Leucine oxidation decreased by 48.6 +/- 8.0%, P = 0.004; thus, nonoxidative leucine disappearance, which estimates protein synthesis, increased significantly by 34.4 +/- 7.7%, P = 0.009. Glutamine's rate of appearance also increased (+32%), mostly through enhanced glutamine de novo synthesis (+42%). In conclusion, short term testosterone administration significantly increases calcium's retention and net forward flow into bone in prepubertal humans, as well as whole body estimates of protein and calcium anabolism. These effects may represent a pure androgen effect, an amplification of growth hormone's action or some combination of these factors.

Conventional and nonconventional uses of growth hormone

Although GH has been available as a therapeutic agent for the GH-deficient child for more than 30 years, the conditions of its use have yet to be optimized. The availability of biosynthetic material has provided researchers with the opportunity to develop the protocols necessary to begin to finally answer the most fundamental questions pertaining to dose, frequency, and duration of treatment. It has also permitted the initiation of prospective trials in a large number of conditions that result in childhood short stature, with the expectation that some or many of them will be treated effectively and safely. Finally, it has opened the door to an entire spectrum of potentially new uses of GH and other growth factors for so-called nonconventional indications. That these have implications that range from the short-term rapid healing of a burn graft site, to the more efficient induction of ovulation, to the long-term preservation of lean body mass has excited the interest of investigators in many fields of medicine and physiology. Thus, the recent progress reported in this paper is really the beginning of the new research that will take place with GH and growth factors.

Evaluation of growth hormone secretion and treatment

The secretion of growth hormone (GH) is regulated by a complex system that includes both neurotransmitters and feedback by hormonal and metabolic substrates. Over the last few years it has been recognized that GH release varies over a wide spectrum from deficient to excessive secretion. The diagnosis of GH deficiency is based on a combination of anthropometric and clinical signs on the one hand and an inadequate stimulated and/or spontaneous GH secretion on the other. There is no distinct boundary between deficient and sufficient GH secretion. The cut-off limit for normal GH release is accordingly relative and has increased over the past decade from 5 to 10 micrograms/l. The effect of GH therapy on growth can be evaluated only after treatment for at least 6 months. There is, therefore, an indisputable need for methods that would reflect growth response soon after the start of treatment. There are several promising biochemical candidates, e.g. the aminoterminal propeptide of type III procollagen, the carboxyterminal propeptide of procollagen I and the bone Gla-protein, which may turn out to be useful early indicators of the growth response to long-term GH therapy.

Growth hormone for short stature not due to classic growth hormone deficiency

The advent of recombinant DNA technology has resulted in potentially unlimited supplies of growth hormone. Sufficient quantities are now available not only for the long-term, uninterrupted treatment of GH-deficient children but potentially for the treatment of non-GH-deficient patients with other short stature or growth attenuating disorders. Short-term studies have demonstrated an improvement in the growth rates of subjects with isolated short stature, Turner syndrome, and chronic renal failure; and additional studies are under way to assess the efficacy of GH therapy of other short stature syndromes. However, the long-term efficacy and possible adverse effects of GH treatment in these situations is not known. Until there has been more experience, GH deficiency should remain the primary indication for GH treatment. Growth hormone should not be considered routine therapy for other conditions associated with or resulting in short stature. However, research should continue in these areas to define which children may benefit from GH treatment.

Effect of oxandrolone on growth and final height in Turner's syndrome

Thirty-two girls with Turner's syndrome aged 11.5-16.7 years were treated with oxandrolone (0.125 mg/kg/day). The treatment period was scheduled to 2 years. Height velocity (HV) was expressed in Standard Deviation Scores (SDS), calculated by growth standards for untreated Danish Turner-girls. For girls with initial bone age below 13 years HV increased significantly from a mean pretreatment value of -0.2 SDS (3.1 cm/year) to +3.5 SDS (5.6 cm/year) in the 1st year of treatment and +2.1 SDS (4.1 cm/year) in the 2nd year. Mean bone age velocity during treatment was 0.9 year/year. Twenty-two girls have reached final height. Predictions of their final height were made by three different methods and compared to observed final height. A significant (p less than 0.001) improvement in the order of 3-4 cm was found for girls with initial bone age below 13 years, while girls with higher initial bone age had no height gain (p greater than 0.3). Side effects were seen in 16% of the girls.

Two-year results of treatment with methionyl human growth hormone in children with Turner syndrome. Dutch Growth Hormone Working Group

Methionyl growth hormone (somatrem) in a daily dosage of 4 IU/m2 body surface area was administered to 16 girls with Turner syndrome. Low dose ethinyl estradiol (0.1 microgram/kg body weight) was added in girls aged 13 years or more. Mean (SD) height velocity increased from 3.4 (0.9) to 7.2 (1.7) and 5.3 (1.3) cm/year in the first and second year, respectively. Bone age advanced 1.8 years over 2 years and predicted adult height was increased. Apart from the occurrence of anti-GH antibodies there were no side effects. In conclusion, somatrem is an efficacious and safe therapy for short stature in Turner syndrome over a period of 2 years. Longer follow-up is needed before conclusions about its effect on final height can be drawn.

Methionyl human growth hormone in Turner's syndrome

Sixteen girls with Turner's syndrome aged 7.9-15.2 years (bone ages 7.0-11.8 years) were given methionyl growth hormone (somatrem) 4 IU/m2 body surface daily, corresponding to 0.9 IU/kg/week. During one year of treatment their mean (SD) height velocity increased from 3.4 (0.9) to 7.2 (1.7) cm/year and height prediction from 148.2 (4.4) to 150.0 (4.4) cm. All the girls except one had a height velocity increment of more than 2 cm/year and these velocities are above the age references for girls with Turner's syndrome. The girl with a low growth response had antibodies against growth hormone with high binding capacity (3.7 U/l). The height velocity increment was inversely correlated with age and bone age, but this might be partly due to the somewhat higher dosage/m2 body surface and kg body weight that the younger patients were given because of the rounding off of the dose. The better results of our study compared with those of other workers who used similar dosages but did not give the drug as often suggest that giving it daily might have increased the growth response as it does in children deficient in growth hormone.

Growth hormone in short, slowly growing children and those with Turner's syndrome

Results of an aborted placebo controlled trial of treatment with human pituitary growth hormone in children with Turner's syndrome and short, slowly growing children are reported. One child in each group had a considerable reduction in growth rate standard deviation score while taking growth hormone. The remaining eight patients with Turner's syndrome and 10 short, slowly growing patients who received growth hormone showed mean rises in growth rate of greater than two standard deviation scores. Neither placebo group showed a mean increase in growth rate standard deviation score. These differences were significant.

Growth hormone treatment in girls with Turner's syndrome. A review of the literature

Most girls with Turner's syndrome seemed to increase their growth rate during the first year of growth hormone treatment. The gain is rarely more than 3 cm/year. In 3 studies the combination of growth hormone and an anabolic steroid resulted in higher growth rates compared to those with each individual compound. The results of long-term treatment (more than one year) also appear to be positive. The impact of growth hormone therapy on final height has not yet been established, however.

Results from the first 2 years of a clinical trial with recombinant DNA-derived human growth hormone (somatrem) in Turner's syndrome

A total of 70 subjects with Turner's syndrome from 11 centres were enrolled in a study of somatrem. After an initial observation period, they were randomly assigned to one of four groups, receiving no treatment (Group 1, control); oxandrolone, 0.125 mg/kg/day (Group 2); somatrem, 0.125 mg/kg 3 times/week (Group 3); or a combination of somatrem and oxandrolone on the above dose regimens (Group 4). After 12-20 months, Groups 1 (control), 2 (oxandrolone) and 4 (combination) were treated with somatrem, 0.125 mg/kg 3 times/week, and oxandrolone, 0.0625 mg/kg/day; Group 3 remained on somatrem, 0.125 mg/kg 3 times/week. All three treatment groups showed a statistically significant increase during year 1 in growth velocity over both their pretreatment growth rates and the control group growth rate. These increases were slightly less in year 2 for the somatrem and combination therapy groups, but remained significantly higher than the year 1 control group growth rate. Plasma IGF-1 levels were elevated in years 1 and 2 in the somatrem and combination groups. Adverse events were few with the somatrem group, though mild virilization occurred with oxandrolone, alone or in combination. Bone age advancement was observed with all treatments but was greater with combination therapy; it was accompanied by height age advancement. The effect of this therapy on predicted adult height was also evaluated.

The effect of oxandrolone on the growth hormone response to growth hormone releasing hormone in children with constitutional growth delay

The effect of treatment with oxandrolone, an anabolic steroid, on GH response to GH-releasing hormone (GHRH) has been evaluated in children with constitutional growth delay. Five subjects, four males and one female, aged 11.0-17.1 years were given oxandrolone 0.1 mg/kg p.o. daily for 2 months, and underwent acute administration of GHRH (GRF 1-40, 1 microgram/kg i.v.) before and after withdrawal of oxandrolone therapy. GHRH administration induced a much greater GH response, evaluated either as a peak plasma GH levels or plasma GH integrated area, after than it did before oxandrolone treatment. These findings indicate that in children with constitutional growth delay oxandrolone increases the sensitivity of somatotrophs to exogenous GHRH and, likely, to the endogenously-released neurohormone.

Growth hormone therapy of short stature

Considerable progress has been made in the diagnosis and treatment of growth hormone-related short stature. Knowledge about growth hormone releasing factor (GRF) and somatomedin C has provided the possibility of distinguishing between hypothalamic and pituitary growth hormone deficiency and growth hormone resistance. It has been shown that treatment with GRF may stimulate growth in certain cases of growth hormone deficiency. Recombinant DNA techniques may, in the near future, provide sufficient amounts of GRF, growth hormone and possibly somatomedin C for clinical use. At present, many countries have prohibited the use of human pituitary growth hormone due to a possible risk of transmission of Creutzfeldt-Jakob disease. It has become increasingly clear that several short children without classical growth hormone deficiency, may increase their growth velocity during growth hormone treatment. There are many medical, psychological, ethical and economical implications involved in the extended treatment of children with short stature. It is necessary to maintain a restricted approach towards the treatment of children with short stature, and such treatment should be prescribed and controlled by a limited number of well-trained paediatric endocrinologists. This article reviews some of the present knowledge in this rapid developing field of paediatric endocrinology.

Oxandrolone in girls with Turner's syndrome. A pair-matched controlled study up to final height

Twenty-six one-year treatment periods on oxandrolone (0.1 mg/kg/day) were studied in 20 patients with Turner's syndrome. Control patients with Turner's syndrome were matched by using the following criteria: difference in bone age being not greater than 0.5 years and difference in the Bayley-Pinneau height prediction not greater than 3 cm. Height and height velocity were compared with standards of girls with Turner's syndrome (10) and expressed in standard deviation scores (SDS). On oxandrolone height velocity increased significantly from -0.3 SDS to + 3.0 SDS. The increase in height velocity was negatively correlated to the bone age at onset of treatment (r = -0.62, p less than 0.01). Height SDS improved by 0.45 SDS in the treated patients whereas it did not change in the control patients. The bone age velocity during the treatment period (including a six-month period after treatment) was 0.75 year/year in the treated, compared to 0.66 year/year in the control patients (NS). 15 of the 20 patients have reached final height. The difference in final height minus predicted height (Bayley-Pinneau) at onset of treatment was taken as a measure of "gain in final height". Seven of those (mean bone age 12.1 years at onset of treatment) were treated for one year only and had--compared to the matched controls--a mean net gain in final height of 2.5 cm (NS). Eight patients (mean bone age 10.1 years at onset of treatment) were treated for two one-year periods and had a significant mean net gain in final height of 5.2 cm. Height predictions calculated by the method of Lenko (14) gave an identical mean net gain in final height (5.1 cm).

Adult height in Turner syndrome with and without androgen therapy

Adult heights of 66 individuals with karyotype documentation of Turner syndrome were analyzed. The mean adult height of 29 individuals given growth-promoting hormones, oxandrolone or fluoxymesterone, did not differ significantly from that of 37 untreated subjects (148.1 +/- 4.7 vs 146.3 +/- 5.5 cm, respectively). The type of X chromosome abnormality did not influence the mean adult height. No significant deleterious effect on height was seen with earlier induction of puberty with estrogens. Parental heights did not appear to influence final adult height. Based on this study, the use of androgens to increase adult height in Turner syndrome cannot be recommended and there appears to be no benefit in delaying induction of puberty with exogenous hormones beyond the mid-teens (14 to 16 years).

The phenotype of 45,X females: an anthropometric quantification

Twenty-five anthropometric measurements were recorded from 48 adult 45,X females, 24 of their first-degree female relatives, and 95 control females. When 45,X females were compared with their female relatives and control females they were smaller in most dimensions, the largest differences being found in weight, stature, sitting height, arm length, leg length, bi-iliac diameter, bitrochanteric breadth and wrist width. No significant differences were found in head dimensions. The comparison after allowance for size showed that 45,X females are relatively smaller in stature, sitting height, arm length, leg length and bitrochanteric breadth and larger in bideltoid breadth, waist breadth, upper arm circumference, chest circumference and triceps skinfold. However, in proportion to height the relative lengths of sitting height, arm length and leg length were similar to those of normal females. The mother-45,X daughter correlation coefficients were significantly larger than those of sister-45,X sister pairs in body dimensions whereas they were more similar in head dimensions. The present findings suggest the presence of genes on the X chromosome having effect on growth in general. This conclusion is in accordance with the results of several earlier studies which have indicated an X-chromosomal influence on stature, tooth size and enamel thickness.

Use of anabolic agents in treatment of short children

As indicated in previous sections of this review, all anabolic steroids produce acceleration in linear growth in children with short stature. However, the rapid masculinization induced by testosterone and other anabolic steroids and especially the disproportionately rapid epiphyseal maturation produced by these compounds have brought this form of therapy for short stature into disrepute. Not all investigators concur that testosterone therapy inevitably results in reduction of eventual adult height attainment and, depending on the age of onset of therapy and the dose employed, it has been reported that adult height attainment equals or exceeds the adult height prediction at the time of instituting therapy. Attempts to synthesize anabolic steroids with improved anabolic/androgenic ratios have been continuing for many years. Among currently available anabolic steroids it appears that the best separation of anabolic and androgenic properties has been attained with oxandrolone. This is reflected by the fact that most recent studies of growth promotion by anabolic steroids have employed this compound. From the results of these studies, it appears that doses of this drug capable of significant stimulation of growth generally do not cause excessive masculinization or unacceptably rapid acceleration of epiphyseal maturation and do not compromise eventual height attainment. Certain studies mentioned above suggest that it might be possible to devise therapeutic programmes employing other anabolic steroids which would produce equally satisfactory results. However, because of the more favourable anabolic/androgenic ratio of oxandrolone it seems likely that the increasing trend toward use of this drug for growth promotion will continue.