Cardiac Performance in Turner’s Syndrome Patients on Growth Hormone Therapy

Abstract

Objectives: To investigate possible cardiac morphofunctional alterations observed in 26 Turner’s syndrome (TS) patients on prolonged high-dose growth hormone (GH) therapy. Study Design: We examined 26 TS subjects treated with rhGH (1 U/kg/week) for a mean period of 4.9 years (range 1–7.8) and 37 age-, weight- and height-matched healthy girls. Left ventricular volume, mass, systolic function, cardiac index, systemic vascular resistance and diastolic function were evaluated by two-dimensional and Doppler echocardiography. Results: Heart rate and systolic blood pressure (BP) were higher in TS patients than in controls, while diastolic BP was lower. Left ventricular volumes, ejection fraction, mass index, M/V ratio and cardiac index did not differ significantly; systemic vascular resistance was slightly decreased. Left ventricular fractional shortening and mean velocity of circumferential shortening were slightly increased while end-systolic meridional stress was decreased in TS. Contractile state was normal in TS. Diastolic function assessment showed a shortening of isovolumetric relaxation and diastolic filling times with an increased atrial contribution and a normal pulmonary venous flow. Conclusion: Cardiac morphology in TS patients on GH therapy is similar to controls. The observed changes in left ventricular systolic and diastolic function should be interpreted as an adaptation to the higher heart rate and reduced peripheral vascular resistance induced by GH therapy.

Growth Hormone Treatment and Left Ventricular Dimensions in Turner Syndrome

“…There was no untreated control group in this study, but cardiac dimensions were within the normal range for these girls and there was no apparent GH dose effect seen in the three different dosage groups. Another study compared cardiac measures in GH-treated girls with TS vs. age and size matched eukaryotic girls (24). They found no difference in LV mass or volume, but did report mild diastolic dysfunction among subjects with TS.…”

“…Given the cardiac involvement in TS there has been concern over potential adverse cardiovascular effects of GH treatment. Two echocardiography studies reported "normal" left ventricular morphology and function in GHtreated girls with TS (19,20); however, these studies had no untreated girls with TS for comparison. In the present retrospective study, we examined cardiac variables using echocardiography in girls with TS that received GH treatment and compared them with a group that were not treated.…”

Epidemiological, endocrine and metabolic features in Turner syndrome

“…Furthermore, by 24-h blood pressure evaluation, it was shown that 57% of all girls had a blunted nocturnal fall in blood pressure ('non-dippers') (171, 172). Radetti et al compared TS girls after 4.9 years of GH treatment with an age-matched control group, and found slight increases in heart rate and systolic blood pressure, as well as minor differences during echocardiography -changes suggested to be due to increased heart rate and reduced peripheral resistance (173). It remains to be seen if there are any very-long-term effects of GH treatment on the cardiovascular system.…”

Arterial hypertension in Turner syndrome

“…Although the short stature of Turner syndrome patients is not attributed to GH insufficiency, treatment with supra-physiologic doses of exogenous recombinant human GH is widely used to increase adult Arterial hypertension in Turner syndrome height. In an Italian cross-sectional study, Turner syndrome girls treated with high doses of GH (1 U/kg/week) had an increased SBP and a decreased DBP compared to age and BSA-matched healthy girls without GH treatment [62]. In a Dutch study comparing different regimens of GH registration, only Turner syndrome girls receiving high doses (2.7 mg/m 2 BSA/day) of GH for several years, showed a decreased DBP, whereas SBP was not affected [62,63].…”

“…In an Italian cross-sectional study, Turner syndrome girls treated with high doses of GH (1 U/kg/week) had an increased SBP and a decreased DBP compared to age and BSA-matched healthy girls without GH treatment [62]. In a Dutch study comparing different regimens of GH registration, only Turner syndrome girls receiving high doses (2.7 mg/m 2 BSA/day) of GH for several years, showed a decreased DBP, whereas SBP was not affected [62,63]. This positive effect of growth hormone on DBP was, however, not sustained after discontinuation [64].…”