Impact of patient characteristics and clinical factors on the decision to initiate growth hormone treatment in Turner syndrome.

BACKGROUND/AIMS: To evaluate factors contributing to the decision to initiate treatment with growth hormone (GH) in patients with Turner syndrome (TS).

METHODS

Data collected included ethnicity, parents' education and work status, mid-parental height, age at diagnosis, karyotype, pubertal development, clinical severity score, bone age, height SDS and ages when GH was proposed and initiated.

RESULTS

GH was proposed to 59 of 72 patients >6 years (82%), and of these 46 (78%) accepted. Reasons for not proposing GH included late diagnosis, good growth and loss to follow-up. GH-treated and untreated girls differed by age at diagnosis (mean +/- SD: 6.8 +/- 4.7 vs. 4.3 +/- 5.1 years; p = 0.04), TS-specific height SDS (0.08 +/- 0.81 vs. 066 +/- 0.87; p = 0.01) and spontaneous puberty (5/46 vs. 4/26, p = 0.024). Mean age at which it was suggested to begin GH was 9.2 +/- 2.9 years. Reasons for parental refusal of GH were not related to reimbursement issues since GH treatment is covered fully by our insurance plan but included concern with other medical issues, mental health problems and fear of injections or unknown side effects.

CONCLUSION

GH treatment was not acceptable to all patients with TS.