EFFECTS OF BIOSYNTHETIC GROWTH HORMONE (GH) TREATMENT (Rx) ON GROWTH IN TURNER'S SYNDROME (TS)

Abstract

The effects of biosynthetic GH (0.375/kg/week) on anthropometric measurements and IGF-1 level were assessed in 13 patients (pts) with TS treated for 4 yrs. Three pts received Synthroid for hypothyroidism; one pt had spontaneous puberty in her 2nd yr of Rx. Before Rx, the mean (±SD) age and bone age (yrs), height and weight (SDS), height velocity (cm/yr) and IGF-1 (ng/ml) were 11.3 + 1.8, 9.5 ± 1.9, −3.5 ± 0.9, −0.9 ± 0.6, 4.6 ± 1.4 and 182 ± 91.7 respectively. Mean IGF-1 which was lower than normal for age at start of Rx (182 ± 91 vg 295) increased significantly (p<.0005) during Rx to levels greater than normal for age; 468 ± 200 vs 260 after 1/2 and 1 yr, 670 ± 205 vs 484 after 2 yrs and 744 ± 104 vs 484 after 3 and 4 yrs of Rx. Height velocity increased significantly to 6.7 ± 1.3 cm/yr in the first 6 months <p<.0005)(n=13), to 6.9 ± 1.2 in the first yr (p<.0005)(n=13) and to 5.8 ± 0.9 in the 2nd yr (<.05)(n=7). During the 3rd yr of Rx, height velocity was 4.8 ± 1.4 cm/yr and similar to baseline while in the 4th yr it was only 3.4 ± 1.4 and significantly less (p<.05) than before Rx. A significant improvement in height SDS was noted only after 2 yrs (p<.05) and persisted throughout the 4th yr of Rx. A disproportionate increase in hands and feet and mild coarsening of facial features were noted in pts treated for more than 3 yrs. This data suggests that GH is effective in increasing height velocity and decreasing the height SDS deficit mostly in the first 2 yra of Rx. It is possible that the apparent weaning effect of GH noted in this study was due to increased bone maturation and that initiation of Rx at an earlier age may produce better results. The fact that the abnormally elevated IGF-1 levels did not result in a greater height velocity suggests that the long bones of pts with TS may be resistant to the effects of IGF-1.

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