Reference values for height, height velocity and weight in Turner's syndrome. Swedish Study Group for GH treatment

New reference growth charts for Japanese girls with Turner syndrome

BACKGROUND

Currently used growth charts for Japanese girls with Turner syndrome (TS) were constructed with auxological data obtained before the secular trend in growth reached a plateau. These charts were published in 1992 and may no longer be valid for the evaluation of stature and growth in girls with TS in clinical settings. Thus, we need to establish new clinical growth charts.

METHODS

The samples for analysis were obtained by a retrospective cohort study. A total of 1867 Japanese girls with TS were registered between 1991 and 2004 for growth hormone (GH) treatment and their pretreatment anthropometric measurements were obtained. Reference growth charts were newly constructed using the LMS method from 1447 girls' cross-sectional data after exclusion of measurements derived from those with the presence of puberty, with previous growth-promoting treatment, or without cytogenetic evidence of TS.

RESULTS

The new clinical reference growth charts differ from the old charts. Secular trends can be detected in both height and weight. Mean adult height on the new chart is 141.2 cm, 3.0 cm taller than the old data. This result seems attributable to the secular trend observed during the same period in Japanese women.

CONCLUSIONS

The newly constructed clinical reference growth charts for Japanese girls with TS seem to be better for the evaluation of growth in girls with TS born after approximately 1970, although selection bias and some other limitations in the present study should be kept in mind.

Inconsistent determination of overweight by two anthropometric indices in girls with Turner syndrome

AIM

To evaluate the prevalence of overweight in girls with Turner syndrome (TS) as classified by the two major anthropometric indices, body mass index (BMI) and weight-for-height (WFH) and to make growth reference charts of them for comparison with those of the normal population.

METHOD

The samples for analysis were obtained from a retrospective cohort. In total, 1447 girls' cross-sectional data were analysed. Subjects were divided into four groups by ages: group A (0-5.99 years), B (6-10.99 years), C (11-15.99 years) and D (16-20.99 years). The cut-off values of overweight by BMI and WFH were those of the 90th percentile and 120 percent, respectively and the prevalence was calculated. For constructing growth reference charts, the LMS method was used.

RESULTS

The prevalence of overweight differed between the two indices. The proportions of the coincidental classification in all subjects, group A, B, C and D were 82.53%, 89.96%, 91.79%, 69.98% and 60.61%, respectively. These differences corresponded to the difference of age-dependent patterns of the two indices from those of the normal population, as judged from the growth charts constructed with all subjects.

CONCLUSION

A discrepancy in the prevalence of overweight as classified by BMI and WFH for girls with TS was detected.

Growth and nutrition disorders in children with cerebral palsy

Growth and nutrition disorders are common secondary health conditions in children with cerebral palsy (CP). Poor growth and malnutrition in CP merit study because of their impact on health, including psychological and physiological function, healthcare utilization, societal participation, motor function, and survival. Understanding the etiology of poor growth has led to a variety of interventions to improve growth. One of the major causes of poor growth, malnutrition, is the best-studied contributor to poor growth; scientific evidence regarding malnutrition has contributed to improvements in clinical management and, in turn, survival over the last 20 years. Increased recognition and understanding of neurological, endocrinological, and environmental factors have begun to shape care for children with CP, as well. The investigation of these factors relies on advances made in the assessment methods available to address the challenges inherent in measuring growth in children with CP. Descriptive growth charts and norms of body composition provide information that may help clinicians to interpret growth and intervene to improve growth and nutrition in children with CP. Linking growth to measures of health will be necessary to develop growth standards for children with CP in order to optimize health and well-being.

Improved accuracy when screening for human growth disorders by likelihood ratios

The standard deviation score (SDS) is a powerful tool for screening for growth-related problems. However, referral rules of the type 'if SDS(Y)<d, then refer' (for some constant d) are not optimal for answering the question: 'Does this child with measurement Y belong to the reference or to the diseased population?'. If the growth standard for the diseased population is known, then the likelihood ratio (LR) and the log-likelihood ratio (LLR) can be calculated for individual measurements. Rules of the type 'if LLR(Y)<e, then refer' are uniformly the most powerful test for any constant e, implying that their receiver operating characteristic curves are above those for all other possible tests based on Y. As an empirical demonstration, both types of rules are applied to longitudinal growth data comparing a group with diagnosed Turner syndrome and a reference group from birth to 10 years of age. Conforming with theory, the LR rules were found to be superior to the SDS rules in terms of sensitivity and specificity. We conclude that the LR is the natural measure for two-group studies that can be easily calculated for individual measurements. The LR is firmly rooted within both statistical and decision theory and can be used to estimate the absolute probability of disease.

Spontaneous final height in Turner's syndrome in Brazil

Short stature is the main factor of emotional impact in girls and women with Turner's syndrome (TS). Growth hormone, alone or associated with sex steroids, allows better adult height. The results of spontaneous final height (FH) in TS can help to evaluate the real cost-benefit of any treatment to improve FH in patients from the same population. The aim of this study was to determine spontaneous FH in women TS and to look for factors which influence it. We evaluated 58 patients with TS who attained FH. Data of weight and length at birth, parents' heights, karyotype, spontaneous puberty and sex hormone replacement were obtained. Mean FH was 144.8 cm and target height 157.0 cm. FH was correlated only to maternal height. The deficit in FH was lower than that found in other Brazilian studies but similar to that described in the literature. This study may help verify the efficacy of therapeutic actions on FH of Brazilian women with TS.

Growth hormone treatment of early growth failure in toddlers with Turner syndrome: a randomized, controlled, multicenter trial

CONTEXT

Typically, growth failure in Turner syndrome (TS) begins prenatally, and height sd score (SDS) declines progressively from birth.

OBJECTIVE

This study aimed to determine whether GH treatment initiated before 4 yr of age in girls with TS could prevent subsequent growth failure. Secondary objectives were to identify factors associated with treatment response, to determine whether outcome could be predicted by a regression model using these factors, and to assess the safety of GH treatment in this young cohort.

DESIGN

This study was a prospective, randomized, controlled, open-label, multicenter clinical trial (Toddler Turner Study, August 1999 to August 2003).

SETTING

The study was conducted at 11 U.S. pediatric endocrine centers.

SUBJECTS

Eighty-eight girls with TS, aged 9 months to 4 yr, were enrolled.

INTERVENTIONS

Interventions comprised recombinant GH (50 mug/kg.d; n = 45) or no treatment (n = 43) for 2 yr.

MAIN OUTCOME MEASURE

The main outcome measure was baseline-to-2-yr change in height SDS.

RESULTS

Short stature was evident at baseline (mean length/height SDS = -1.6 +/- 1.0 at mean age 24.0 +/- 12.1 months). Mean height SDS increased in the GH group from -1.4 +/- 1.0 to -0.3 +/- 1.1 (1.1 SDS gain), whereas it decreased in the control group from -1.8 +/- 1.1 to -2.2 +/- 1.2 (0.5 SDS decline), resulting in a 2-yr between-group difference of 1.6 +/- 0.6 SDS (P < 0.0001). The baseline variable that correlated most strongly with 2-yr height gain was the difference between mid-parental height SDS and subjects' height SDS (r = 0.32; P = 0.04). Although attained height SDS at 2 yr could be predicted with good accuracy using baseline variables alone (R(2) = 0.81; P < 0.0001), prediction of 2-yr change in height SDS required inclusion of initial treatment response data (4-month or 1-yr height velocity) in the model (R(2) = 0.54; P < 0.0001). No new or unexpected safety signals associated with GH treatment were detected.

CONCLUSION

Early GH treatment can correct growth failure and normalize height in infants and toddlers with TS.

Turner syndrome: update on current therapies

New treatments for girls and women with Turner syndrome (monosomy X) have dramatically improved their quality of life and health. Young girls are treated with growth hormone to enhance adult height, and with estrogen to induce and maintain feminization, and prevent osteoporosis. Vigilant screening for otitis, thyroid disease, hypertension, dyslipidemia and diabetes allows for early and effective medical treatment of these common problems. Comprehensive cardiovascular evaluation and regular monitoring of aortic diameter are essential to identify individuals at risk for dissection or rupture. Insights derived from the study of metabolic risk factors in women with Turner syndrome may illuminate gender differences in atherosclerotic heart disease.

Growth hormone treatment of non-growth hormone-deficient growth disorders

Although a large body of data on efficacy and safety of growth hormone (GH) treatment for various non-growth hormone-deficient (GHD) growth disorders has accumulated from a combination of clinical trial and postmarketing sources in the last 20 years or more, there remain limitations. Clinical trial data have the advantage of direct comparison of well-matched, randomized patient groups receiving treatment (or not) under comparable conditions and, as such, provide the highest quality evidence of efficacy. Clinical trials, however, are typically too small for any statistically valid assessment for safety, which is more comprehensively addressed using postmarketing data. Consequently, while the efficacy of GH treatment in children with non-GHD growth disorders has been solidly established and, based on the combination of the rigor of the clinical trial data and numerical power of the postmarketing data, no major concerns exist regarding safety, additional long-term data are required.

Growth and health in children with moderate-to-severe cerebral palsy

BACKGROUND

Children with cerebral palsy frequently grow poorly. The purpose of this study was to describe observed growth patterns and their relationship to health and social participation in a representative sample of children with moderate-severe cerebral palsy.

METHODS

In a 6-site, multicentered, region-based cross-sectional study, multiple sources were used to identify children with moderate or severe cerebral palsy. There were 273 children enrolled, 58% male, 71% white, with Gross Motor Function Classification System levels III (22%), IV (25%), or V (53%). Anthropometric measures included: weight, knee height, upper arm length, midupper arm muscle area, triceps skinfold, and subscapular skinfold. Intraobserver and interobserver reliability was established. Health care use (days in bed, days in hospital, and visits to doctor or emergency department) and social participation (days missed of school or of usual activities for child and family) over the preceding 4 weeks were measured by questionnaire. Growth curves were developed and z scores calculated for each of the 6 measures. Cluster analysis methodology was then used to create 3 distinct groups of subjects based on average z scores across the 6 measures chosen to provide an overview of growth.

RESULTS

Gender-specific growth curves with 10th, 25th, 50th, 75th, and 90th percentiles for each of the 6 measurements were created. Cluster analyses identified 3 clusters of subjects based on their average z scores for these measures. The subjects with the best growth had fewest days of health care use and fewest days of social participation missed, and the subjects with the worst growth had the most days of health care use and most days of participation missed.

CONCLUSIONS

Growth patterns in children with cerebral palsy were associated with their overall health and social participation. The role of these cerebral palsy-specific growth curves in clinical decision-making will require further study.

Evidence for early initiation of growth hormone and transdermal estradiol therapies in girls with Turner syndrome

Results from the first randomized, controlled trial of growth hormone (GH) therapy in girls with Turner syndrome (TS) followed to final height firmly establish that GH increases final adult stature. It is widely believed that the efficacy of GH is dependent upon the duration of therapy and dosing (longer duration and higher dose give taller final height). In a recent observational study involving more than 1500 French girls with TS, multivariate analyses demonstrated that the age at initiation of GH therapy accounted for a large percentage of the variance (44%) in response. Age at initiation of estrogen therapy was the second most important factor in determining GH effect (later initiation, taller final height), accounting for 22% of the variance. Overall, 0.3 cm in adult height was gained for every year that estrogen therapy was delayed. However, analyses of the French data restricted to patients with induced puberty revealed that those treated with percutaneous estradiol attained a height 2.1cm taller than those using oral estradiol or other estrogen preparations. In another study, girls receiving GH therapy (n=14) who were randomized to receive intramuscular (IM) depot estradiol early (12.0-12.9 years) attained at least as much height as those who initiated it late (14.0-14.9 years). These results are consistent with the observations in adult women that oral estrogens decrease IGF-I serum levels and suppress the IGF-independent metabolic effects of GH, while transdermal estrogens do not. Taken together, these studies suggest that girls with TS should begin GH therapy as soon as growth failure is demonstrated and that puberty should be induced with transdermal or IM estradiol. Girls for whom height is normalized with GH therapy in early childhood have the opportunity to undergo puberty at an age-appropriate time and still achieve a normal adult stature.

Aortic distensibility and dimensions and the effects of growth hormone treatment in the turner syndrome

In Turner's syndrome (TS), an increased risk for cardiovascular malformations exists, including aortic dilation of unknown cause. Abnormal biophysical wall properties may play an important role. Magnetic resonance imaging has been successfully used to assess aortic size and wall distensibility. The aim of this study was to assess aortic biophysical properties and dimensions in TS. Thirty-eight former participants of a growth hormone (GH) dose-response study in TS (mean age 12 +/- 2 years, mean body surface area 1.7 +/- 0.2 m2) and 27 controls (mean age 21 +/- 2 years, mean body surface area 1.8 +/- 0.1 m2) were enrolled. Previously, patients had been assigned to 1 of 3 groups treated with different GH dosages: group A (0.045 mg/kg/day), group B (0.067 mg/kg/day), and group C (0.09 mg/kg/day). All underwent magnetic resonance imaging > or =6 months after GH discontinuation to determine aortic dimensions and distensibility at 4 predefined levels: (1) the ascending aorta, (2) the descending aorta, (3) the level of the diaphragm, and (4) the abdominal aorta. Patients had larger aortic diameters at all but level 4 and tended to have reduced distensibility at level 3. Distensibility in group A was significantly less compared with that in group C at level 4. Compared with controls, patients in group A had larger aortic diameters at all but level 4 and reduced distensibility at level 4. The results for patients in groups B and C were not different from those for controls. In conclusion, patients with TS formerly treated with GH have dilated aortas and signs of impaired wall distensibility. The severity of abnormalities seems related to the GH dose, with a beneficial effect of a larger GH dose on the abnormalities.

Validation of growth charts for girls with Turner syndrome

Growth charts, which describe the natural course of growth in Turner syndrome (TS) patients, are commonly used in studies in lieu of control groups. While analysing data, various charts produce different final height estimations and height-gain predictions. The choice of an appropriate chart should be the first task when assessing effects of growth hormone treatment. The purpose of this study was to establish the most appropriate growth chart for the subsequent analysis of growth rate in the patients with TS observed initially for a short time without treatment in our clinic. We propose the criteria that a standardised chart should meet. The obtained height-standardised values (height standard deviation score -- Ht SDS) should represent normal distribution with a mean of 0 and standard deviation of 1; their initial mean value and mean change in these values during observation without treatment should not be different from 0. We studied 62 untreated girls with TS using three different growth charts. The values of Ht SDS based on the Lyon chart showed a significant difference from normal distribution (p < 0.05). Only the mean value of an initiaent from 0 (p = 0.088). The mean change of the Ht SDS value based on Lyon and Ranke charts during the follow-up period was not statistically different from 0 (p > 0.05), whereas the difference was statistically significant when the Wisniewski chart was used. Only the Ranke chart correctly characterised TS girls in our clinic. This analysis indicates the importance of careful selection of an appropriate growth chart for an observed population, before applying it to evaluate the effects of hormonal therapy.

Quality of life after growth hormone therapy and induced puberty in women with Turner syndrome

OBJECTIVE

To evaluate health-related quality of life (HRQoL) in young women with Turner syndrome (TS) after long-term growth hormone (GH) therapy and induced puberty and to analyze whether HRQoL was influenced by auxologic parameters, pubertal development, or subjective parameters.

STUDY DESIGN

The study group comprised 49 women with TS, mean (standard deviation) age 19.6 (+/-3.0) years, all former participants of 2 GH studies, > or =6 months after GH discontinuation. Puberty was induced by estrogen treatment, at mean age 12.9 (+/-1.1) years. HRQoL was measured by self-reports of the 2 generic questionnaires, SF36 and TAAQOL. As an additional source of information on HRQoL, we applied parental proxy reports.

RESULTS

HRQoL of the women with TS was normal. Remarkably, the women with TS had higher HRQoL scores on some of the scales, including "social functioning" and "role-emotional." Satisfaction with height and breast development had a positive influence on several HRQoL scales.

CONCLUSIONS

The young women with TS who reached normal height and had age-appropriate pubertal development reported normal HRQoL. The relatively high scores on some of the HRQoL scales can be explained by an estrogen effect or by a possible response shift, indicating a different internal reference in women with TS. We hypothesize that GH and estrogen treatment positively influenced HRQoL in young women with TS.

Adult height in sixty girls with Turner syndrome treated with growth hormone matched with an untreated group

The main clinical feature of Turner syndrome (TS) is growth failure, with a mean spontaneous adult height ranging between 136 and 147 cm, according to the specific curves of various populations. Though a classical deficiency of GH has not been generally demonstrated, GH has been administered since 1980 in trials, using replacement doses just initially, with a subsequent trend to increase it. We report the outcome of GH therapy given at the fixed dose of 0.33 mg/kg/week in 60 TS girls observed until adult height; 59 untreated TS girls, matched for auxological, karyotypical characteristics and time of observation, born within the same decade served as controls to evaluate GH efficacy. The calculation of the gain in cm over PAH was performed on specific Italian Turner curves, as well as height evaluation as SD score and growth velocity. The same calculations were made using Lyon references and Tanner standards. The mean CA at the beginning of GH treatment was 10.9 +/- 2.76 yr (range 4.5-15.9). Mean adult height of treated group was 151 +/- 6.1 cm with a gain over the PAH calculated at start of therapy (142.9 +/- 5.3 cm) of 8.2 +/- 3.9 cm. Ns change was observed between the PAH at first observation (143.6 +/- 7.0 cm) and adult height (144.3 +/- 5.6 cm) in the control group. Treatment was well tolerated, no relevant side effects were observed, glucose metabolism resulted no more affected than in untreated subjects, IGF-I levels remained within 2 SD. Our results in 60 TS girls, though the dose remained unchanged throughout the treatment, show a good response, characterized by a striking variability in each patient (mean gain in cm over PAH at adult height of 8.17 +/- 3.9, range 3-21 cm), and significant also in comparison with the control group. As the chronological age at start of therapy ranged between 4.5 to 15.9 yr, the results were further evaluated dividing the patients into two groups, according to the age, < or >11 yr. Thirty girls were <11 yr (mean 8.7 +/- 1.76 yr) and 30 were >11 yr (mean 13.2 +/- 1.4 yr). The gain in cm over the PAH in each group was, respectively, 8.1 +/- 3.4 and 8.2 +/- 4.3 cm without any significant difference between the two groups, showing no negative correlation between the CA at the beginning of GH and the response to treatment.

Individual growth curve models for assessing evidence-based referral criteria in growth monitoring

The goal of this study is to assess whether a growth curve model approach will lead to a more precise detection of Turner sydnrome (TS) than conventional referral criteria for growth monitoring. The Jenss-Bayley growth curve model was used to describe the process of growth over time. A new screening rule is defined on the parameters of this growth curve model, parental height and gestational age. The rule is applied to longitudinal growth data of a group of children with TS (n=777) and a reference (n=487) group. The outcome measures are sensitivity, specificity and median referral age. Growth curve parameters for TS children were different from reference children and can therefore be used for screening. The Jenss-Bayley growth model, which uses all longitudinal measurements from birth to a maximum age of 5 years with at least one measurement after the age of 2, together with parental height and gestational age can achieve a sensitivity of 85.2 per cent with a specificity of 99.5 per cent and a median referral age of 4.2 (the last measurement between the age of 2 and 5 of each child is considered to be the moment of referral). Sensitivity increases by 2 percentage points when decreasing the specificity to 99 per cent. The Jenss-Bayley growth model from birth to a maximum age of 8 years with at least one measurement after the age of 2, together with parental height results in a sensitivity of 89.0 per cent with a specificity of 99.5 per cent and a median referral age of 6.1. For a specificity of 98 per cent, we obtain a sensitivity of 92.3 per cent. In comparison to conventional rules applied to the same data, sensitivity is about 11-30 percentage points higher at the same level of specificity for the Jenss-Bayley growth rule. We conclude that from the age of 4, growth curve models can improve the screening on TS to conventional screening rules.

Down syndrome, Turner syndrome, and Klinefelter syndrome: primary care throughout the life span

Down syndrome, Turner syndrome, and Klinefelter syndrome constitute the most common chromosomal abnormalities encountered by primary care physicians. Down syndrome typically is recognized at birth, Turner syndrome often is not recognized until adolescence,and many men with Klinefelter syndrome are never diagnosed. Although each syndrome is caused by an abnormal number of chromosomes, or aneuploidy, they are distinct syndromes with learning disabilities and a predisposition toward autoimmune diseases,endocrinologic disorders, and cancers. Optimal health care requires a thorough knowledge of the unique health risks, psychoeducational needs, functional capabilities, and phenotypic variation associated with each condition. Syndrome-specific health care should complement standard preventive health care recommendations. Checklists and syndrome-specific growth grids should be used. Ongoing communication between specialists and primary care physicians and between pediatric and adult clinicians is essential. Support groups and Internet resources can benefit affected individuals and their families immensely.

Towards evidence based referral criteria for growth monitoring

AIMS

To evaluate the performance of growth monitoring in detecting diseases. Turner's syndrome (TS) is taken as the target disease.

METHODS

Case-control simulation study. Three archetypal screening rules are applied to longitudinal growth data comparing a group with TS versus a reference group from birth to the age of 10 years. Main outcome measures were sensitivity, specificity, and median referral age.

RESULTS

Clear differences in performance of the rules were found. The best rule takes parental height into account. Combining rules could improve diagnostic accuracy.

CONCLUSION

Growth monitoring is useful to screen for TS. A combined rule that takes absolute height SDS, parental height, and deflection in height velocity into account is the best way to do this. Similar research is needed for other diseases, populations, and ages, and the results should be synthesised into evidence based referral criteria.

Final height in girls with turner syndrome after long-term growth hormone treatment in three dosages and low dose estrogens

Although GH treatment for short stature in Turner syndrome is an accepted treatment in many countries, which GH dosage to use and which age to start puberty induction are issues of debate. This study shows final height (FH) in 60 girls with Turner syndrome treated in a randomized dose-response trial, combining GH treatment with low dose estrogens at a relatively young age. Girls were randomly assigned to group A (4 IU/m(2).d; approximately 0.045 mg/kg/d), group B (first year, 4 IU/m(2).d; thereafter 6 IU/m(2).d), or group C (first year, 4 IU/m(2).d; second year, 6 IU/m(2).d; thereafter, 8 IU/m(2).d). After a minimum of 4 yr of GH treatment, at a mean age of 12.7 +/- 0.7 yr, low dose micronized 17beta-estradiol was given orally. After a mean duration of GH treatment of 8.6 +/- 1.9 yr, FH was reached at a mean age of 15.8 +/- 0.9 yr. FH, expressed in centimeters or SD score, was 157.6 +/- 6.5 or -1.6 +/- 1.0 in group A, 162.9 +/- 6.1 or -0.7 +/- 1.0 in group B, and 163.6 +/- 6.0 or -0.6 +/- 1.0 in group C. The difference in FH in centimeters, corrected for height SD score and age at start of treatment, was significant between groups A and B [regression coefficient, 4.1; 95% confidence interval (CI), 1.4, 6.9; P < 0.01], and groups A and C (coefficient, 5.0; 95% CI, 2.3, 7.7; P < 0.001), but not between groups B and C (coefficient, 0.9; 95% CI, -1.8, 3.6). Fifty of the 60 girls (83%) had reached a normal FH (FH SD score, more than -2). After starting estrogen treatment, the decrease in height velocity (HV) changed significantly to a stable HV, without affecting bone maturation (change in bone age/change in chronological age). The following variables contributed significantly to predicting FH SD score: GH dose, height SD score (ref. normal girls), chronological age at start of treatment, and HV in the first year of GH treatment. GH treatment was well tolerated. In conclusion, GH treatment leads to a normalization of FH in most girls, even when puberty is induced at a normal pubertal age. The optimal GH dosage depends on height and age at the start of treatment and first year HV.

Turner syndrome in childhood and adolescence

Turner syndrome (TS) is the most common chromosomal disorder causing short stature in females. The short stature is caused at least in part by haploinsufficiency of the short stature homeobox (SHOX) gene. Complete spontaneous puberty may occur in approximately 16% of patients, with spontaneous pregnancy in up to 4%. The final height of untreated TS girls is 86-88% of the mean adult female height. Growth hormone (GH) given alone or with oxandrolone improves final height. The major factors determining the outcome of GH therapy are the dose of GH used and the number of years of GH therapy prior to oestrogenization. Pubertal induction in TS should be individualized bearing in mind growth optimization and psychological issues. Adolescents and adults with TS may face a range of medical, fertility and psychosocial issues. Psychological support for TS individuals and families is important throughout life and should ideally be provided by both health professionals and TS support groups.

Body mass index (BMI) in Turner Syndrome before and during growth hormone (GH) therapy

OBJECTIVE

To study whether body mass index (BMI) is different in girls with Turner syndrome (TS) compared to normal girls, and whether BMI in TS is affected by growth hormone (GH) treatment.

DESIGN

A retrospective cross-sectional study.

SUBJECTS

2468 girls with TS enrolled in the National Cooperative Group Study (NCGS), a collaborative surveillance study for assessing GH-treated children.

MEASUREMENTS

BMI and BMI standard deviation score (BMI SDS) at baseline and during GH treatment were computed from height and weight data.

RESULTS

BMI in TS patients increases with age as expected. However, BMI SDS increased starting at about age 9 y. A similar pattern of increase in BMI SDS was observed after each year of GH treatment for up to 4 y, but GH treatment did not change the magnitude of increase. BMI and BMI SDS curves before and during GH treatment were essentially superimposable.

CONCLUSION

These findings suggest that mechanisms specific for TS are responsible for the age-related increase in BMI SDS. This increase was unaffected by GH treatment.

Turner syndrome: a pattern of early growth failure

The purpose of this study was to determine the pattern of early growth in girls with Turner syndrome. Analysis was performed on a total of 464 longitudinal measurements of height, obtained from birth to 8 years of age from 37 girls with Turner syndrome who did not have significant cardiac disease or autosomal abnormalities. All data were obtained prior to the initiation of any hormonal therapy. Mean height SDS fell from -0.5 at birth to -1.5 at age 1 year and -1.8 at age 1.5 years. Growth curves fitted using the first two components of the infancy-childhood-puberty model of growth revealed that growth failure was due to (a) mild growth retardation in utero, (b) slow growth during infancy, (c) delayed onset of the childhood component of growth and (d) slow growth during childhood. Physicians should consider the diagnosis of Turner syndrome in any girl with an unexplained failure to thrive or with short stature, even during the first 2 years of life.