The current use of estrogens for growth-suppressant therapy in adolescent girls.

OBJECTIVE: To assess the current prevalence of growth-suppressant therapy using oral estrogens for tall adolescent girls among U.S. pediatric endocrinologists. METHODS: A questionnaire was mailed to pediatric endocrinologists practicing in the United States, asking how many patients each clinician had recently treated for tall stature using oral estrogens, whether he/she continued to offer such treatment, reasons for offering or declining to offer it, criteria for initiating and terminating treatment, choice of estrogen, and typical doses, durations, and effects. RESULTS: Of 411 respondents, 92 (22%) reported having treated 1-5 girls for tall stature during the preceding five years. Only 4 (1%) had treated more than 5 cases during this period. Growth-suppression treatment was currently offered by 137 respondents (33.3%). Reasons for doing so included parents' and patients' concerns about stature and the adverse social effects of unusually tall stature. Reasons for not offering such treatments were that its long-term risks are unknown, that tall stature is not a disease, and a lack of referrals. Few clinicians initiated treatment if predicted mature height was below 183 cm. Treatment was typically terminated based on evidence of epiphyseal fusion, usually within less than two years, although extended treatments were common. Frequently reported adverse effects included weight gain, nausea/vomiting, areolar or nipple pigmentation, headache, and irregular menses. CONCLUSIONS: Although treatment is less commonly initiated than in the past, many pediatric endocrinologists continue to offer oral estrogens to suppress growth for tall adolescent girls.

Estrogens reduce plasma histidine-rich glycoprotein (HRG) levels in a dose-dependent way.

Plasma levels of histidine-rich glycoprotein (HRG) were investigated in three groups of women receiving a different dose of estrogens. First, the effect of low-dose estrogen was studied in a group of 83 postmenopausal women who were treated with 0.625 mg conjugated estrogens (CE). No significant change from baseline levels was found at the end of cycle 3 and cycle 13. Secondly, in 15 mothers and 23 daughters using oral contraceptives (OC) containing 30-50 micrograms ethinyl estradiol (EE) daily the mean HRG level was 14% and 24% lower than in a group of 144 mothers and 134 daughters not taking oral contraceptives, respectively (p < 0.05). Finally, in 11 excessively tall prepuberal girls who received 300 micrograms EE daily to reduce their final height the mean plasma HRG levels were decreased by 68% (p < 0.005). The effect of progestogens administered during low-dose and high-dose estrogen therapy appeared to be minor. The results from these three studies indicate that estrogens reduce plasma HRG levels in a dose-dependent way.

[Fulminant acne in Klinefelter syndrome treated with testosterone. A side effect of anti-tallness therapy]. / Acne fulminans bei Klinefelter-Syndrom unter Testosteron. Eine Nebenwirkung der Antihochwuchstherapie.

Acne lesions usually do not occur in patients with Klinefelter's syndrome (47 XXXY). But a 19 year old patient with Klinefelter's syndrome, under therapy with testosteronenantat (500 mg every two weeks over a period of 18 months) for treatment of excessively tall stature developed acne fulminans. Following discontinuation of testosterone treatment and isotretinoin therapy over 16 weeks skin lesions healed almost completely although with severe scars. In conclusion, high doses testosterone-treatment in excessively tall boys needs the additional care of dermatologist when mostly after a 7 months period acne begins to develop under this treatment.

Estrogen-induced weight gain cannot be predicted in individuals.

The effect of high estrogen doses on weight was studied in 36 adolescent girls with familial tall stature treated to reduce adult height. Mean weight gain during the first year was 9.0 +/- 3.6 kg. Thereafter, there was no or minimal gain on continued treatment. The largest weight velocity occurred during the first 6 months. Within that period, it was most marked during the first 5 weeks, probably due to early water retention. The gain (total, in different groups of patients and in treatment periods of different duration) did not correlate with height and weight before treatment expressed in absolute values or standard deviation scores. It is concluded that the weight gain induced by long-term estrogen treatment cannot be predicted quantitatively before treatment in individuals, and that heavy or fat girls do not necessarily gain more weight than light and lean girls.

Reduction of adult height in tall girls.

Assessment of the results of treatment of tall girls with estrogens by comparing actual mature height with predicted mature height is unreliable, unless the accuracy of prediction has been tested in untreated tall girls. We report such an investigation in 14 tall girls who were treated with estrogens and in 14 untreated tall girls. Of the three prediction methods, those of Bayley and Tanner were reliable in our hands, whereas the method of Roche was less adequate. The mean reduction of height by treatment was about 7 cm using Tanner's method of prediction, 10 cm when Bayley's method was used. The standard deviation of the difference between actual and predicted height as found in untreated girls makes it hazardous to assess the amount of height reduction in the individual treated case with any certainty.