Effect of different oestrogen doses on final height reduction in girls with constitutional tall stature

Abstract

The effects of different doses of oestrogens in constitutionally tall girls were evaluated in two centres for paediatric endocrinology. In one centre, 38 girls were treated with a high oestrogen dose of 0.3 to 0.5 mg ethinyloestradiol (EE) daily. In the other, 44 girls received a comparably low dose of 0.1 mg EE per day. Height prediction (HP), chronological age (CA), and height at the onset of treatment were comparable in both groups. Although the duration of treatment was significantly longer in those receiving the low dose, the cumulative oestrogen dose was still significantly lower. The dose of EE had no effect on final height reduction (high dose group: 4.9 +/- 2.6 cm, low dose group: 5.1 +/- 2.4 cm). Final height was more reduced in both groups when treatment was started at an early bone age (BA) (less than or equal to 13 years). No serious side effects were observed in either group, however weight gain was more pronounced in girls receiving the higher dose. We conclude that treatment of constitutionally tall girls with low doses of oestrogens is equally effective in reducing the final height as the usually administered high doses. The lowest effective dose has to be determined in a randomized, prospective clinical trial.

Sex Steroid Treatment of Constitutionally Tall Stature*

“…All girls experienced spontaneous menstrual bleeding within 3 to 22 weeks after termination of therapy. The same was observed in most later follow-up studies in which first menstruation was reported within 1-6 months after cessation of treatment, in most cases even after the first month (103,114,127,130). Amenorrhea of longer than 6 months after cessation of height-reductive therapy was reported in about 5% of the cases (175).…”

“…Some reports are in favor of this finding (109,122,123,125) while others observed no difference (103,107,128,130). In our study (101), premenarcheal girls seem to benefit more from therapy than postmenarcheal girls.…”

“…These mean results are less than previously claimed Various studies show (as illustrated in Fig. 2) that the effect of treatment was more pronounced when treatment had been started at a younger BA (105,108,112,123,130,131). However, others did not find such a relationship (103).…”

“…In girls, pregnancy, which is the ultimate 'proof' of complete reversibility of hypothalamo-gonadal suppression, has been reported in various single cases (112,113,127,128,130,131,189). In our own study, information on a total of 63 pregnancies was obtained from 40 previously treated tall women.…”

“…In most studies, unwanted side effects have been reported only during treatment or shortly after discontinuation of therapy (109,112,113,127,128,130,131,183,189,196,197). Most side effects were found to be mild and reversible (see Table 9).…”