Demography, auxology and response to recombinant human growth hormone treatment in girls with Turner's syndrome in the Kabi Pharmacia International Growth Study. International Board of the Kabi Pharmacia International Growth Study

Growth curves for Turkish Girls with Turner Syndrome: Results of the Turkish Turner Syndrome Study Group

OBJECTIVE

Children with Turner syndrome (TS) have a specific growth pattern that is quite different from that of healthy children. Many countries have population-specific growth charts for TS. Considering national and ethnic differences, we undertook this multicenter collaborative study to construct growth charts and reference values for height, weight and body mass index (BMI) from 3 years of age to adulthood for spontaneous growth of Turkish girls with TS.

METHODS

Cross-sectional height and weight data of 842 patients with TS, younger than 18 years of age and before starting any therapy, were evaluated.

RESULTS

The data were processed to calculate the 3rd, 10th, 25th, 50th, 75th, 90th and 97th percentile values for defined ages and to construct growth curves for height-for-age, weight-for-age and BMI-for-age of girls with TS. The growth pattern of TS girls in this series resembled the growth pattern of TS girls in other reports, but there were differences in height between our series and the others.

CONCLUSION

This study provides disease-specific growth charts for Turkish girls with TS. These disease-specific national growth charts will serve to improve the evaluation of growth and its management with growth-promoting therapeutic agents in TS patients.

Spontaneous puberty in girls with early diagnosis of Turner syndrome

OBJECTIVE: To verify if the frequency of spontaneous pubertal development among girls with Turner syndrome (TS) diagnosed in infancy and childhood is greater than that of patients diagnosed later. SUBJECTS AND METHODS: Thirty three girls aged < 10 years at the time of diagnosis were evaluated regarding pubertal development. The frequency of spontaneous puberty was compared with that of girls aged > 13 years diagnosed at the same service. RESULTS: Sixteen of 32 informative patients had signs of spontaneous puberty, a frequency greater than that of patients diagnosed later. In six patients, there was no progression of puberty; menarche occurred in six, and one became pregnant, but the fetus was a stillborn. Spontaneous puberty was absent in all cases with 45,X karyotype. CONCLUSIONS: The greater prevalence of spontaneous puberty in girls whose diagnosis was not based on pubertal delay suggests that, among those diagnosed later, there is a bias towards patients with hypogonadism. Arq Bras Endocrinol Metab. 2012;56(9):653-7

Recombinant human growth hormone: old and novel uses

Recent studies of the growth hormone insulinlike growth factor I (IGFI) axis suggest that these hormones are involved in several physiologic processes, in addition to growth. Thus, several lines of evidence indicate an increasingly important role for recombinant human growth hormone as a part of the modern therapeutic armamentarium. In addition to the treatment of children with growth hormone deficiency, administration of growth hormone appears to be of considerable benefit to girls with Turner syndrome, children with chronic renal failure, and adults with growth hormone deficiency or human immunodeficiency virus (HIV) wasting syndrome. Moreover, its therapeutic use is being investigated in other conditions, such as children with idiopathic short stature, the healthy elderly, and the critically ill. However, long-term surveillance among growth hormone recipients is needed to fully evaluate its risk-benefit profile.

The growth pattern and final height of girls with Turner syndrome with and without human growth hormone treatment

BACKGROUND

Shortness is the most frequent and quite disturbing characteristic of girls with Turner syndrome (TS). Human growth hormone administration (hGH) to girls with TS increases growth velocity (GV), but a favorable effect on final height (FH) has not been documented. The aim of this study was to evaluate the effect of hGH administration on the growth pattern and FH in girls with TS.

METHODS

The study group was comprised of 123 girls with TS who were cared for in our center. Eighty-two of these girls received hGH (mean dose, 0.78 +/- 0.12 IU/kg/week), given subcutaneously 5 to 7 times per week for a period of 2.2 +/- 1.2 years (hGH group). The mean chronological age (CA) and bone age (BA) at hGH initiation were 11.5 +/- 2.5 years and 9.7 +/- 2.3 years, respectively. The remaining 41 girls did not receive hGH and are designated as the untreated control group. In both groups, gonadal steroids were given for pubertal initiation and maintenance.

RESULTS

The GV during the first year of hGH therapy (GV1) was higher than the year before hGH (6.3 cm/year vs 4.0 cm/year) and higher than the GV of the untreated group at a similar CA (4.4 cm/year). The GVs during the second (GV2) and third (GV3) year of hGH treatment (5.4 and 4.9 cm/year, respectively) were lower, but still higher in the hGH group, in comparison with the untreated group (GV2, 4.2 cm/year; GV3, 3.4 cm/year). GV1, GV2, and GV3 were negatively related to age and to BA at hGH initiation. The FH of the 35 hGH-treated girls was not significantly different from the FH of the 27 untreated girls (146.1 cm vs 144.0 cm). The Delta target height-FH was not significantly different in the two groups. The FH standard deviation score of the hGH-treated group was positively related to height standard deviation score for CA at treatment initiation (r = +0.73), maternal height (r = +0.57), target height (r = + 0.66), and birth weight (r = +0.54), but was unrelated to CA or BA at start of therapy or to hGH dose.

CONCLUSIONS

hGH therapy in girls with TS, in the dose and duration of treatment applied in this study, significantly accelerated GV but did not significantly improve FH.

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

As Northern Europeans are currently the tallest people in the world, specific growth charts for girls with Turner's Syndrome from this area are needed. Based on height and weight measurements from 598 girls with Turner's Syndrome (372 from the Netherlands, 108 from Denmark, 118 from Sweden) not treated with growth-promoting substances and without signs of spontaneous puberty, we constructed growth charts for height-for-age, height-velocity-for-age, weight-for-age, weight-for-height and Body Mass Index for age. Reference tables and regression equations for mean and standard deviation are provided allowing calculation of Standard Deviation Scores. The height and height velocity curves show a low birth length, gradual deviation from the normal percentile curves without pubertal growth spurt, and a prolonged growth until the early 20s. Mean adult height was 146.9 +/- 7.8 cm. Mean weight-for-age was lower than in normal reference children but height-adjusted weight was higher, except in infancy and early childhood. Further studies are required on the factors influencing the weight-height relationship in Turner's Syndrome.

Variable effect of growth hormone on growth and final adult height in Scottish patients with Turner's syndrome

The aim of this work was to assess the outcome of recombinant growth hormone (rGH) therapy in a large unselected group (72) of patients with Turner's syndrome (TS), 26 of whom have reached final height. Growth data were collected from Scottish patients with TS and outcome was assessed in three ways: response to therapy in the first year, response in subsequent years and final height. Phenotypic, auxological, genetic and biochemical factors, all of which may have affected the first-year response, were investigated. Fifty-one percent of the cohort had a clinically "good" first-year response to therapy and 49% had a "poor" response, a "good" response was defined as a change in the TS standard deviation score (SDS) of +0.5 or more and a "poor" response as a change in the TS SDS of less than +0.5. The percentage of children showing a positive change in TS SDS after 2, 3 and 4 years of therapy declined (88%, 78%, 41%). Mean (range) final height was 142.6 (133.4-153.6) cm, mean (range) pretreatment TS SDS was -0.27 (-2.1 to +1.09) and mean (range) final TS SDS was -0.05 (-1.4 to +1.59). Thirteen (50%) patients attained a final height that was greater than projected, eleven did not attain their projected final height and two achieved their exact projected final height. Short girls with TS appear to benefit more from rGH supplementation than tall girls, but otherwise there was no significant correlation between any of the parameters studied and the response to treatment. It is concluded that large-scale prospective studies are still required to assess the impact of rGH on final height in TS and to identify factors responsible for the variability in response.

Current and potential therapeutic uses of growth hormone and insulin-like growth factor I

The accepted and potential uses of GH and IGF-I are summarized in Table 1. In general, the research on the therapeutic uses of IGF-I is at a much earlier state of development compared with GH The use of GH in the treatment of children with GH deficiency is well accepted, and its use in the treatment of short stature of renal failure also is widely accepted. The FDA has approved the use of GH in children with short stature caused by GH insufficiency and renal failure. The use of GH in patients with Turner syndrome has not been approved by the FDA, although it has been approved in several other countries. The use of GH for the treatment of adults with GH deficiency is approved in several countries but it is not approved in the Unites States. With the exception of the cases with GHIS, the use of IGF-I as a therapeutic agent cannot yet be regarded as of proven usefulness. The potential uses of GH and IGF-I are an area of active investigation and will continue to enlighten our understanding of human disease and disorders of growth.

[Current aspects of Turner syndrome]

Recent progress in the clinical, genetic and therapeutic knowledges of Turner's syndrome are presented. The quality of life of Turner's syndrome can be much improved by early treatment with recombinant human growth hormone which significantly increases the patient's final height, and appropriate oestrogenic therapy at pubertal and adult ages. However, this requires an early diagnosis. Consequently, a karyotype must be performed in every girl with delayed growth, even in the absence of clinical features of the Turner's syndrome.