Effect of Discontinuation of Long-Term Growth Hormone Treatment on Carbohydrate Metabolism and Risk Factors for Cardiovascular Disease in Girls with Turner Syndrome

Pareren, Yvonne K. van; Keizer‐Schrama, Sabine M.P.F. de Muinck; Stijnen, Theo; Sas, Theo C J; Drop, Stenvert L. S.

doi:10.1210/jc.2002-020789

Cited by 45 publications

(45 citation statements)

References 41 publications

(47 reference statements)

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“…The literature supports a strong correlation between TS, insulin sensitivity and GH therapy [7, 10,13,14,15,16,17]. Our study confirms that GH therapy reduces insulin sensitivity, but at its cessation there is a return to pre-therapy values.…”

Section: Resultssupporting

confidence: 87%

“…After the cessation of GH therapy, insulin sensitivity returned to pre-treatment levels, as has been reported by other authors [16]. After GH therapy has finished, lower levels of insulin are necessary to guarantee good glycaemic homeostasis.…”

Section: Discussionsupporting

confidence: 78%

“…Many studies have evaluated the effects of GH therapy on glucose tolerance in TS [7,12,13,14,15,16,17]. Some authors found no modifications [12], whereas others found an increase in insulin resistance, particularly with long-term GH therapy [7, 13, 14], which disappeared after discontinuation of GH [16] (table 1).…”

Section: Introductionmentioning

confidence: 99%

“…Some authors found no modifications [12], whereas others found an increase in insulin resistance, particularly with long-term GH therapy [7, 13, 14], which disappeared after discontinuation of GH [16] (table 1). …”

Section: Introductionmentioning

confidence: 99%

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Turner Syndrome, Insulin Sensitivity and Growth Hormone Treatment

Mazzanti

Bergamaschi²,

Castiglioni³

et al. 2005

Horm Res Paediatr

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Mild insulin resistance appears to be an early metabolic defect in girls with Turner syndrome (TS). Impaired glucose tolerance has been reported in 10–34% of patients with TS, and type 2 diabetes mellitus is 2–4 times more common and occurs at a younger age in girls with TS than in the general population. In a mixed longitudinal and cross-sectional study, we analysed carbohydrate tolerance and insulin sensitivity in 46 children and adolescents with TS who reached their final height after long-term treatment (mean 6.3 ± 2.5 years) with growth hormone (GH: 0.33 mg/kg/week [0.05 mg/kg/day]), and in 36 of these patients who were followed-up after the cessation of GH therapy (mean follow-up, 2.6 ± 2.5 years; range, 1–9.5 years). Patients with TS were compared with an age-matched female control group. Insulin sensitivity appeared to be lower in patients with TS than in controls, even before the start of GH therapy. As in controls, insulin sensitivity decreased with age in patients with TS, and levels were lower in those aged >12 years than in those aged <12 years. GH therapy resulted in good catch-up growth in patients with TS, with final height significantly higher than projected height evaluated before the initiation of GH therapy. Insulin sensitivity increased after 7–8 years of therapy and, on the cessation of GH therapy, returned to pre-treatment levels. The increase in insulin sensitivity seen on the cessation of GH therapy appeared to be influenced negatively by body mass index and triglyceride levels, and correlated positively with the number of years since cessation of GH therapy. As in the general population, excess weight and an abnormal lipid profile, in particular excess triglyceride levels, worsened insulin sensitivity. In conclusion, our study confirms that GH therapy reduces insulin sensitivity, but at its cessation there is a return to pre-therapy values. We therefore report a progressive improvement in carbohydrate tolerance and insulin function in patients with TS, despite an increase in age.

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Section: Resultssupporting

confidence: 87%

Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Turner Syndrome, Insulin Sensitivity and Growth Hormone Treatment

Mazzanti

Bergamaschi²,

Castiglioni³

et al. 2005

Horm Res Paediatr

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“…None of the other body proportions (hand, head circumference, bi-iliacal and biacromial diameter, sitting height) changed significantly with GH treatment (228). Interestingly, discontinuation of GH treatment in the aforementioned study led to a slight increase in BMI 6 months later (229). At present, no GH treatment studies in an adult Turner syndrome population have examined a possible impact on body composition.…”

Section: Effects Of Gh Treatmentmentioning

confidence: 85%

Epidemiological, endocrine and metabolic features in Turner syndrome

2004

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Turner syndrome is one of the more common genetic disorders, associated with abnormalities of the X chromosome, and occurring in about 50 per 100 000 liveborn girls. Turner syndrome is usually associated with reduced adult height, gonadal dysgenesis and thus insufficient circulating levels of female sex steroids, and infertility. A number of other signs and symptoms are seen more frequently with the syndrome. Morbidity and mortality are increased. The average intellectual performance is within the normal range. A number of recent studies have provided new insights with respect to epidemiology, cardiology, endocrinology and metabolism. Treatment with GH during childhood and adolescence allows a considerable gain in adult height, although verylong-term consequences of this treatment are not clear. Puberty has to be induced in most cases, and female sex hormone replacement therapy is given during the adult years. The proper dose of hormone replacement therapy (HRT) has not been established, and, likewise, benefits and/or drawbacks from HRT have not been thoroughly evaluated. Since the risk of cardiovascular and endocrinological disease is clearly elevated, proper care during adulthood is emphasized. In summary, Turner syndrome is a condition associated with a number of diseases and conditions which are reviewed in the present paper.

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Turner Syndrome

Davenport

2010

Management of Genetic Syndromes

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Effect of Discontinuation of Long-Term Growth Hormone Treatment on Carbohydrate Metabolism and Risk Factors for Cardiovascular Disease in Girls with Turner Syndrome

Cited by 45 publications

References 41 publications

Turner Syndrome, Insulin Sensitivity and Growth Hormone Treatment

Turner Syndrome, Insulin Sensitivity and Growth Hormone Treatment

Epidemiological, endocrine and metabolic features in Turner syndrome

Turner Syndrome

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