EFFECTS OF SHORT TERM ADMINISTRATION OF PHYSIOLOGICAL DOSES OF HUMAN GROWTH HORMONE IN THREE PATIENTS WITH TURNER'S SYNDROME

Growth hormone treatment in Turner's syndrome

A total of 21 patients with Turner's syndrome were treated with pituitary hGH and/or somatrem for 1-2 years. Plasma non-esterified fatty acid increased significantly from 0.52 +/- 0.06 to 1.30 +/- 0.09 mEq/litre at 4 hours after injection of hGH, 4 IU (mean +/- SEM, p less than 0.001). Basal plasma IGF-1 levels were within the normal range; however, they increased significantly at 24 hours after the first three daily injections of hGH, 4 IU (basal, 0.92 +/- 0.14 units/ml; 24 hours, 1.39 +/- 0.16 units/ml; 48 hours, 1.68 +/- 0.19 units/ml; 72 hours, 1.91 +/- 0.22 units/ml; p less than 0.001). For long-term treatment, patients were given hGH, 4-16 IU for 1-2 years. Their height velocity increased to 5.5 +/- 1.2 cm/year and 5.1 +/- 0.6 cm/year in the first and second year of the treatment, respectively. These values were greater than the pretreatment value of 3.6 +/- 0.8 cm/year (p less than 0.001). Antibody against hGH was observed in 60% of the patients at the end of 12 months of somatrem treatment. Otherwise there were no significant changes in physical, blood or urine examinations. These results indicate that hGH treatment is useful for the acceleration of growth velocity in patients with Turner's syndrome.

The phenotype of 45,X females: an anthropometric quantification

Twenty-five anthropometric measurements were recorded from 48 adult 45,X females, 24 of their first-degree female relatives, and 95 control females. When 45,X females were compared with their female relatives and control females they were smaller in most dimensions, the largest differences being found in weight, stature, sitting height, arm length, leg length, bi-iliac diameter, bitrochanteric breadth and wrist width. No significant differences were found in head dimensions. The comparison after allowance for size showed that 45,X females are relatively smaller in stature, sitting height, arm length, leg length and bitrochanteric breadth and larger in bideltoid breadth, waist breadth, upper arm circumference, chest circumference and triceps skinfold. However, in proportion to height the relative lengths of sitting height, arm length and leg length were similar to those of normal females. The mother-45,X daughter correlation coefficients were significantly larger than those of sister-45,X sister pairs in body dimensions whereas they were more similar in head dimensions. The present findings suggest the presence of genes on the X chromosome having effect on growth in general. This conclusion is in accordance with the results of several earlier studies which have indicated an X-chromosomal influence on stature, tooth size and enamel thickness.

Growth hormone deficiency and growth hormone therapy in Ullrich-Turner-syndrome

In a girl with Ullrich-Turner-Syndrome (gonadal dysgenesis 45, XO) and growth hormone deficiency, 10 U of human growth hormone/m2 body surface area/week increased the growth rate from 2.0 to 4.1 cm/year. Doses of up to 36 U/m2/week did not improve the growth rate in 4 girls with Ullrich-Turner-Syndrome who had normal plasma growth hormone concentration and increation. We conclude that growth hormone therapy is unsuccessful in dwarfism in Ullrich-Turner-Syndrome and should be reserved for patients with proven growth hormone deficiency.

Metabolic effects of human growth hormone in corticosteroid-treated children

The effects of administered human growth hormone (HGH) were evaluated in dwarfed, prepubertal children who were receiving long-term corticosteroid therapy for a chronic disease. During 11 complete metabolic balance studies, the eight corticosteroid-treated children demonstrated impaired response to large doses of HGH with minimal nitrogen and no phosphorus retention. In contrast, two hypopituitary subjects and two asthmatic children not receiving corticosteroid responded to the same preparations of HGH with nitrogen, potassium, and phosphorus retention. Six corticosteroid-treated children were given large doses of HGH (40-120 mg/wk for 4 to 8 months and showed no improvement in their retarded rate of growth, whereas the hypopituitary subjects showed accelerated growth during administration of 10-15 mg of HGH/wk. It is concluded that dwarfism in steroid-treated children results from corticosteroid-induced antagonism of the effects of HGH at the peripheral tissue level.