Tall girl therapy
The above title does not mean the use of tall girls in therapy or the therapy of tall girls, but rather the therapy that may be used to help prevent little tall girls from growing into big tall girls. This implies three things: that some tall girls are dissatisfied with the prospect of towering over the average male, that there is a means of predicting which girls are going to grow tall, and that there is effective therapy available.
In their review of 15 years of management and treatment of tall girls in Australia, Wettenhall, Cahill and Roche stated that they can confidently answer that there are indeed some preadolescent and adolescent girls of above-average height who do not relish the prospect of much further growth, that it is possible to predict final height from height at an earlier age, and that they have . treatment regimen that will help slow down the growth of these girls. They took as the definition of tall stature any height more than two standard deviations above the mean for the community. By this criterion 2.3% of girls in any chronologic age group are unusually tall. In Australia there are probably 41 000 girls under the age of 15 who are unusually tall, but few seek medical attention: many are not concerned about their stature, others have no idea that anything can be done.
Tall girl therapy, US National Library of Medicine, National Institutes of Health, Can Med Assoc J, NCBI PubMed PMC1956556, 1976 Jan 10.
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Attempts to control stature are reasonable when a fairly good estimate of final height can be made, treatment will reduce this final figure appreciably, and short- and long-term side effects are minimal.
In the reports on stature control since Goldzieher’s paper in 19562 the use of various estrogen preparations has been assessed, and all but two reports have claimed success. Wettenhall and colleagues1 treated 168 girls with stilbestrol between 1959 and 1973; the data for 87 of these form the basis of their report.
Mature stature was estimated from the tables of Bayley and in which present height and skeletal maturity (hand, wrist and knee) are considered. Treatment was given if the estimated mature height was greater than 177.0 cm or if the estimated growth potential was sufficient to justify treatment. (Treatment was not given to 282 other tall girls who constilted the authors.) The mean chronologic age was 13 years at the beginning of therapy (range, 11 to 15.8 years). Mean stature was above the 97th percentile for Australian girls. Estimated mature stature ranged from 172.2 to 189.2 cm (the smallest girl was treated because she showed promise as a ballet dancer – no profession for a tall girl). Estimated growth potential ranged from 1.3 to 16.8 cm. Treatment was begun in 46 girls before menarche and in 41 girls after menarche.
Treatment was preceded by a careful study of the patient, including tests to exclude organic disease that might cause excessive growth, and by discussion with the girl and both her parents of the advantages and disadvantages of being tall. In determining the optimum height for starting treatment one should, of course, allow sufficient time for a treatment effect while avoiding the induction of menstruation at too early an age. Thus, treatment was not begun by the authors in any girl less than 10 years old.
Stilbestrol was given in a dosage of 1 mg/d for the first week, 2 mg/d for the next week, and then 2 mg/ d until mature (or nearly mature) stature was reached. Cases were reviewed at 3-month intervals. The mean duration of therapy was 2.1 years (range, 0.6 to 4.1 years). Mean age at final meassurement of stature was 17.6 years (range, 14.1 to 25.3 years). The mean “apparent effect” of therapy was 3.5 cm growth in height, apparent effect being obtained by subtracting final stature from estimated mature stature. A few girls did not respond to treatment but some were saved up to 10 cm of excess height. All said that they were glad they had been treated. Treatment was more effective if it was started early and also if it was begun before menarche.
When therapy was begun before menarche, ii regular menstruation was apt to occur. This irregularity also happened after menarche; however, administration of norethindrone for 4 days a month controlled this. There were no long-term menstrual problems after therapy was discontinued. Pigmentation occurred in some girls but always faded later. Nausea was controlled by decreasing the dosage temporarily. Diet controlled obesity when it appeared, and in any case the excess weight was shed later. All girls improved psychologically. Mild thrombosis occurred in one girl. Ovarian cysts developed in two girls; the relation of this occurrence to stilbestrol therapy is not clear.
The authors point out that there is no convincing evidence that estrogen causes cancer in “normal” girls or young women. They also note that ethinyl estradiol in comparable dosage (0.12 mg/ d) is perhaps now the agent of choice.
To sum up, they believe that effective control of stature of potentially tall girls is possible but should be carried out under careful supervision after careful assessment.
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