This protocol applies to children with Turner syndrome who present with short stature, a declining rate of growth, or other evidence of growth failure, provided epiphyses remain open.
Short stature and growth failure — defined as a rate of growth below normal or declining — are key indications for intervention in Turner syndrome. Treatment may be considered from as young as 2 years of age when these features are present, and remains an option later as long as epiphyses have not closed.
Management involves growth hormone (GH) treatment, introduced at a specified starting dose with provisions for titration based on the individual's response. The complete dosing parameters, monitoring intervals, and adjustment algorithm are detailed in the full protocol.
The primary objective is to maintain height percentile at or above the pre-treatment level — assessed at least every 6 months — with an increasing percentile considered evidence of treatment effect. IGF-I should be kept within the normal range for age, pubertal stage, and sex.
DOI: 10.1093/ejendo/lvae050
Treatment may be offered from as young as 2 years of age in the following circumstances: evidence of growth failure (rate of growth below normal or declining), short stature, or likelihood of short stature.
GH treatment may be offered later, as long as epiphyses remain open.
We recommend a starting GH dose of 45-50 μg kg⁻¹ day⁻¹ or (1.3-1.5 mg m⁻² day⁻¹) in most instances, increasing to a maximum of 68 μg kg⁻¹ day⁻¹ (2.0 mg m⁻² day⁻¹) if response is suboptimal and/or adult height potential remains substantially compromised.
Maintenance of height percentile equivalent to, or greater than, the pre-treatment height percentile on a female population-based growth chart or increasing percentile on a TS-specific height chart, provides evidence of treatment effect.
We suggest generally maintaining IGF-I within the normal range for age, pubertal stage, and sex.
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