Optimization of treatment in Turner's syndrome.

We discuss treatment for short stature and hypogonadism in patients with Turner's syndrome, using recombinant human growth hormone (GH) and estrogen. We discuss the starting dose of GH, age at start of treatment, and association with oxandrolone or low dose estrogen therapy before 12 years old. We provide recommendations for optimization of therapy for best final height and induction of puberty with estrogen therapy. Our experience in the Children's Endocrinology Clinic in "La Paz" University Hospital, Madrid, is that 83% of our patients need estrogen therapy and only 17% had spontaneous menarche. The average age for puberty induction was 12.2 years, and the average duration of estrogen treatment was 2.1 years. The average final height obtained using GH treatment was 151.3 cm with a gain related to predicted height of 6.8 cm.