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started once the child starts faltering on standard growth chart. Recombinant
hGH therapy can be safely initiated in these patients as early as 9 months of
age, as shown in the Turner–Toddler study. The initiation of rhGH therapy at an
early age helps in the attainment of near-normal target height and induction of
puberty at an appropriate age.- What is the evidence for the use of rhGH in children with TS?
Therapy with rhGH has been shown to be effective in promoting linear growth
in children with TS. The landmark clinical trials using rhGH in children with
TS are shown in the table given below. The Canadian study was the first ran-
domized–controlled trial in children with TS which clearly demonstrated the
benefit of rhGH therapy in children with TS. The Turner–Toddler study showed
that rhGH can be safely initiated as early as 9 months of age, while the Dutch
study showed the optimal dose of rhGH for growth promotion in children with
TS. The Dutch study has shown that although a higher dose of rhGH (4 IU/m^2 /
day × 1 year followed by 6 IU/m^2 /day × 6 years) was effective than low dose
(4 IU/m^2 /day × 7 years), increasing the dose further (4 IU/m^2 /day × 1 year,
6 IU/m^2 /day × 1 year, 8 IU/m^2 /day × 5 years) did not result in significant
improvement in height.StudiesCanadian
study (2005)Toddler–Turner
study (2007) Dutch study (1999)
No. of patients
recruited154 89 68No. of patients
completed study104 79 65Age (years) 7–13 0.75–4 2–11
Inclusion criteria
based on height<10th centile on WHO
chart and height
velocity <6 cm/year- <50th percentile for
healthy Dutch girls
Baseline Height SDS
(GH vs. placebo)−0.2 vs. −0.1
(TS chart)−1.4 vs. −1.8
(CDC)No. of patients treated
with rhGH61 45 68Controls 43 43 –
Duration of rhGH
therapy (years)5.7 2 7Dose of rhGH used 0.30 mg/Kg/week
(6 days a week)50 μg/Kg/day
(0.3 mg/Kg/
week)Group A 4 IU/m^2 /day ×
7 years
Group B 4 IU/m^2 /day ×
1 year, 6 IU/m^2 /day ×
6 years
Group C 4 IU/m^2 /day ×
1 year, 6 IU/m^2 /day ×
1 year, 8 IU/m^2 /day ×
5 years8 Turner Syndrome