Estrogen Treatment for Tall Girls?
ABSTRACT & COMMENTARY
Synopsis: Thirty constitutionally tall adolescent girls were treated with daily estrogen to reduce their ultimate height. The achieved height was 5.2 ± 3.3 cm less than the predicted height. Weight gain was the major side effect.
Source: Weimann E, et al. Oestrogen treatment of constitutional tall stature: A risk-benefit ratio. Arch Dis Child 1998; 78:148-151.
Estrogens are sometimes given in high doses in order to attempt to decrease tall stature in girls. The aim of this study was to obtain data considering efficiency, side effects, and acceptance of the treatment of 50 constitutionally tall girls who were treated with conjugated estrogens (7.5-11.25 mg/d). The mean (SD) adult height predictions for these girls were 188.3 ± 4.4 cm and the achieved height was 5.2 ± 3.3 cm less than the predicted height. A greater reduction from final predicted height occurred when treatment was started at an early bone age (< 13 years) and with a remaining growth potential of greater than 10 cm. Even postmenarcheal girls, however, had a mean reduction of 4.8 ± 3.2 cm. The main side effects were considerable weight gain (> 10 kg), an increase in triglyceride concentrations (37.5% of the patients), and increased platelet aggregation (60% of the patients). Overall, 85% of the patients were satisfied with the treatment, and 15 regretted having had it.
COMMENT BY WALTER ANYAN, MD
Five centimeters is the answer to remember if one is asked about the effectiveness of using high-dose estrogen to reduce expected mature height. Although no report has pinpointed whether the growth reduction occurred in the legs, the trunk, or in both, clinical experience from the past 30 years has shown that estrogens accelerate epiphyseal maturation, and the extent of the reduction in mature height increases in proportion to the bone age at initiation of therapy decreases. In this report, Premarin, a group of conjugated estrogens, was used, and the dosage was three or more times the usual physiologic dose. Others who have used ethinylestradiol found that an effective dose was three or more times the regular dose. Understandably, treatment will be usually continued until the epiphyses are nearly mature, and the patient will be exposed to a large amount of estrogen for several years. Important side effects, such as weight gain and thromboembolic phenomena, must be anticipated. The girls who have the greatest potential to benefit from this treatment are the youngest, and it is a formidable challenge to obtain informed consent from a 10 year old who is destined to be a tall adult. The recent prominence and popularity of the Women's National Basketball Association may deter interest of girls for this treatment-particularly because it is associated with significant weight gain. (Dr. Anyan is Professor of Pediatrics and Director of the Adolescent Medicine Division at Yale University School of Medicine.)