Short Stature and Growth Failure in Turner Syndrome When Initial Growth Hormone Therapy Has Not Maintained Height Percentile
This protocol addresses a child with Turner syndrome who is showing evidence of growth failure — a rate of growth that is below normal or declining — or who has short stature, with epiphyses still open. The clinical concern is inadequate maintenance of height percentile.
An initial course of Growth Hormone (GH) therapy has not achieved its primary goals: maintenance of height percentile equivalent to or greater than the pre-treatment height percentile (assessed at least every 6 months), and IGF-I maintained within the normal range for age, pubertal stage, and sex. This protocol defines the next clinical step when those targets have not been reached.
When the initial GH dose has not produced an adequate growth response, the evidence supports an upward adjustment of the growth hormone dose — subject to individual monitoring and a defined upper ceiling. The complete algorithm, thresholds, and monitoring schedule are in the full protocol.
Full dose values, decision criteria, and monitoring intervals are available via the link below.
Maintenance of height percentile equivalent to or greater than the pre-treatment height percentile on a female population-based growth chart, assessed at least every 6 months.
References
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.
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