EFFECT OF GROWTH HORMONE (GH) TREATMENT ON BONE METABOLISM IN ULLRICH-TURNER-SYNDROME (UTS)

Abstract

Background and Methods. The cause of decreased bone mineialization in UTS and the effect of different doses of GH on bone turnovet ate unknown. We therefore measured total (AP) and bone (BAP) alkaline phosphatase and osteocalcin (Oc) as markers of osteoblastic bone formation and the hydroxyptoline-creatinine-latio (OH-P/Ct) in fasting morning urine as an index of osteoclastic bone degradation, as well as IGF-I as an index of the effect of exogenous GH on its receptor.

Patients and Study Protocol. 80 untreated prepubertal girls with UTS (bone age 3 - 11yr) were studied prior to and most of them after a 21-33 months-therapy with 3 different doses of GH (Humatrope, Lilly), given subcutaneously: 2U/sqm/day (UTS-2U, n = 27), 3 U/sqm/day (UTS-3U, n = 24) and 4 U/sqm/day (UTS-4U, n = 19). The results were compared to 8 patients with growth hormone deficiency (GHD) prior and during GH therapy with 2 U/sqm/day and 25 healthy age-matched controls (basal levels of bone metabol.)

Results. IGF-I was normal in UTS-groups and GHD. AP, BAP and Oc were decreased prior to GH treatment and showed a lower response than in the patients with GHD d(receiving only 2 U), even at a dose of 4 U in patients with UTS. In contrast, OHP/C₁ was normal before treatment and showed a dose-dependent increase in the 3 UTS-groups.

Conclusions. Our study indicates that children with UTS have reduced osteoblastic bone formation but unimpaired osteoclastic bone degradation and that this imbalance may worsen during treatment with high doses of GH.

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