In adults with GHD, the FDA-approved labeling states that the starting dosage of GH should be very low ( to mg/day). The product labeling further states that this dose should be increased gradually on the basis of clinical and biochemical responses assessed at monthly intervals. The biochemical marker generally relied upon for GH is the IGF-I level in serum. Values of IGF-I should be maintained in the normal age- and sex-adjusted range. The literature indicates that the dose may be increased, on the basis of individual patient requirements, to a maximum of mg daily in patients younger than 35 years of age, and to a maximum of mg daily in patients older than 35 years of age. Of note, this dose is substantially less than GH replacement doses in children and adolescents, in whom the dose is based on weight.
There has been no consensus regarding the efficacy and safety of oxandrolone (Ox) in addition to growth hormone (GH) in girls with Turner syndrome (TS), the optimal age of starting this treatment, or the optimal dose. This collaborative venture between Dutch, UK and US centers is intended to give a summary of the data from three recently published randomized, placebo-controlled, double-blind studies on the effects of Ox. The published papers from these studies were reviewed within the group of authors to reach consensus about the recommendations. The addition of Ox to GH treatment leads to an increase in adult height, on average – cm. If Ox dosages< mg/kg/day are used, side effects are modest. The most relevant safety concerns are virilization(including clitoromegaly and voice deepening) and a transient delay of breast development. We advise monitoring signs of virilization breast development and possibly blood lipids during Ox treatment, in addition to regular follow-up assessments for TS. In girls with TS who are severely short for age, in whom very short adult stature is anticipated,or in whom the growth rate is modest despite good compliance with GH, adjunctive treatment with Ox at a dosage of – mg/kg/day starting from the age of 8–10 years onward scan be considered.