Sex Steroid Treatment of Constitutionally Tall Stature

Estrogen Treatment in Tall Girls

Abstract

In 1956 Goldzieher introduced estrogen as a treatment of excessive growth in adolescent girls. Since then, many reports have appeared describing the height-reducing effect of high-dose estrogen therapy in tall girls.

Sex Steroid Treatment of Constitutionally Tall Stature, The Endocrine Society, dx.doi.org/10.1210/edrv.19.5.0345, April 20, 2011.

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Many investigators, mainly in the United States, treated excessively tall girls with conjugated estrogens. In Western Europe, others used ethinyl estradiol (EE) in varying dosages usually combined with a progestogen 7–10 days each month to induce cyclic bleeding and to avoid overstimulation of the endometrium. Norethisterone, medroxyprogesterone, and dydrogesterone have been used as progestagen, 5–10 mg/day. The two last preparations, in particular, show low to absent androgenic effects.

In the past, estrogens have been administered in the form of stilbestrol, 1–5 mg per day. However, since it has been reported to cause vaginal cancer in the female offspring of women treated during pregnancy, stilbestrol is not a suitable treatment modality. It has the additional disadvantage of inducing marked pigmentation and hyperkeratosis of the nipple.

Estradiol esters, such as estradiol-valerate and -benzoate, have been used since they were considered to be more ‘physiological’ than oral ethinyl estradiol (EE) or conjugated estrogens. A disadvantage is that three injections per cycle are required. Considering all advantages and disadvantages, it appears that EE is the preparation of choice, since the dose is standardized, administration is easy, and side effects are not more marked or frequent than with any other preparation.

Whether the estrogens are given continuously or cyclically seems to be of minor importance for the effect on height or for the resumption of regular menstrual cycles after discontinuation of treatment. It seems that the pituitary-gonadal axis tolerates continuous therapy for a period of 1–2 yr very well. In the 1960s most practitioners used 500? g EE; in the 1970s 200–300 ?g were used, and in the 1980–1990s a dosage of 100 ?g/day was claimed to be sufficient. Whether even lower dosages (e.g., 35 ?g daily) are equally effective remains to be assessed in a prospective clinical trial.

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