Age-Related Perception of Stature, Acceptance of Therapy, and Psychosocial Functioning in Human Growth Hormone-Treated Girls with Turner’s Syndrome1

Abstract

This study evaluated the perception of stature, acceptance of therapy, and psychosocial functioning in relation to age at onset and time on treatment during 2 yr of GH therapy in 31 girls with Turner's syndrome grouped by age (group A: 3.7-5.8 yr, n = 9; group B: 7.2-11.8 yr, n = 13; group C: 12.5-16.4 yr, n = 9). The growth response after 2 yr was significant in the 3 groups when calculated in terms of growth norms for untreated Turner girls (mean increase in height SD score: +1.2, +1.5, and +1.1, respectively). The effect was less marked in terms of growth norms for normal girls, particularly in group B (+0.5 SD score). Height was perceived as a problem by most patients, except in the youngest girls at the start of treatment (group A) and in the majority of the adolescents after 2 yr of GH therapy (group C), without evidence of relation to growth response during therapy. The GH injections were fairly well accepted by all patients, except those younger than 6 yr. In all patients, expected adult height was unrealistic and became more realistic with age, whereas no consistent changes were observed in relation to growth response to GH therapy. The Child Behavior Checklist revealed elevated mean scores at the behavioral subscales of attention problems (group A and B), social problems, withdrawal, and anxiety-depression (most obviously in group B). No significant changes were seen during GH therapy. In group C, an elevated mean social problem score at the Youth Self Report and a low mean social self-esteem score at the Self-Esteem Inventory were observed before therapy and showed a significant improvement during 2 yr of GH treatment. These results, however, might be biased due to an increase in social desirability during therapy. We conclude that the perception of height, acceptance of GH therapy, and psychosocial functioning in girls with Turner's syndrome show important differences between age groups, with only slight changes observed during GH therapy.

Induction of Puberty in the Hypogonadal Girl – Practices and Attitudes of Pediatric Endocrinologists in Europe

“…This survey was not intended to become a consensus conference or issue guidelines but rather to evaluate and summarize common clinical practice in Europe and attitudes of pediatric endocrinologists in Europe. It is clear that while it is important to know about physicians’ attitudes, one should also know about the perception of height, acceptance of therapy and psychosocial functioning in the hypogonadal girls and their families in different populations [10, 11, 12, 13, 14]. Only few such surveys involving the patients themselves have been conducted [11].…”

“…It is clear that while it is important to know about physicians’ attitudes, one should also know about the perception of height, acceptance of therapy and psychosocial functioning in the hypogonadal girls and their families in different populations [10, 11, 12, 13, 14]. Only few such surveys involving the patients themselves have been conducted [11]. Adjustments of estrogen and growth hormone doses over time [10, 12]have been proposed.…”

Depression in Turner Syndrome: A Systematic Review

“…Among those studies that evaluated depressive symptoms via a validated questionnaire (Quality of Data Level 2) results were as follows: regarding symptoms severity, five studies (28% of subgroup) reported that individuals with TS had high severity depressive symptoms (Cunniff, Hassed, Hendon, & Rickert, 1995;Mao et al, 2015;Rickert et al, 1996;Rovet, 1993;Saad et al, 2014), 10 studies (56%) reported average severity symptoms (Chadwick, Smyth, & Liao, 2014;Freriks et al, 2015;Kiliç et al, 2005;Lagrou et al, 1998;McCauley, Ito, & Kay, 1986a;McCauley, Ross, Kushner, & Cutler, 1995;McCauley, Sybert, & Ehrhardt, 1986b;Ross et al, 1996;Rovet & Ireland, 1994;van Pareren et al, 2005), and three (17%) studies did not report data that were interpretable with regard to symptom severity (Lasaite, Lasiene, & Lasas, 2010;McCauley, Feuillan, Kushner, & Ross, 2001;Schmidt et al, 2006). Regarding symptom frequency, six studies (33%) demonstrated that subjects with TS were more frequently experiencing depressive symptoms as compared to those without TS (Chadwick et al, 2014;Kiliç et al, 2005;Lasaite et al, 2010;McCauley et al, 1986b;Saad et al, 2014;Schmidt et al, 2006), nine (50%) demonstrated an average frequency of symptoms (Cunniff et al, 1995;Freriks et al, 2015;Lagrou et al, 1998;McCauley et al, 1986aMcCauley et al, , 1995Rickert et al, 1996;Ross et al, 1996;Rovet & Ireland, 1994;van Pareren et al, 2005), one (6%) reported that individuals with TS were less frequently depressed than the i...…”

Clinical developmental, neuropsychological, and social–emotional features of Turner syndrome

“…Overall, many subtypes of anxiety have been reported, including generalized anxiety, social anxiety, specific phobias, and obsessive-compulsive behaviors (Cardoso et al, 2004;El Abd, Patton, Turk, Hoey, & Howlin, 1999;Kilic et al, 2005;Moonga, Pinkhasov, & Singh, 2017). Despite many descriptive studies of anxiety and self-concept in TS (Kilic et al, 2005;Schmidt et al, 2006), a more precise breakdown of anxiety often results in conflicting information and may be affected by methodology including a reliance on self-report (Kilic et al, 2005;Lagrou et al, 1998). Because of the frequency of social anxiety in individuals with TS, it is important to consider that social desirability may be a confounding factor in the response pattern of self-report measures.…”