Effect of growth hormone treatment on craniofacial growth in Turner's syndrome

Abstract

A cephalometric study was performed in 19 patients with Turner's syndrome, aged 8.7–16.5 years. A lateral roentgencephalogram was taken before and after two years of treatment with biosynthetic growth hormone in a dose of 24 IU/m2/week. During two years of growth hormone treatment, the mandibular length increased mainly due to vertical growth. The initially posteriorly rotated mandible showed an anterior rotation, although the normal position was not reached. The other linear measurements and angles did not change during treatment. No indications were found for an increase in the disproportionate growth or for excessive chin growth as a sign of acromegaly during growth hormone treatment. In conclusion, growth hormone treatment in patients with Turner's syndrome resulted in an increase in mandibular length, mainly due to vertical growth of the ramus and in the anterior rotation of the mandible.

Craniofacial morphology in Turner syndrome patientstreated with growth hormone

“…Both jaws were retrognathic, even though maxillary and mandibular body average length increased under the influence of GH therapy. These results are in accordance with previous studies that have also found retrognathic jaws [24][25][26] and increase in mandibular ramus [24][25][26] and corpus lengths 25,26 in TS girls treated with GH. Bimaxillar retrognathism, also present in TS girls 2,3,5-7 and adult patients 4,8 that were not treated with GH, used to be explained by flattened cranial base 3 and reduced lengths of maxilla and mandible.…”

“…The growth of mandibular ramus under the influence of GH treatment causes anterior rotation of mandible in TS patients, 24,26 as well as in idiopathic short stature boys and GH deficient boys. 18 Similarly, in this study mandibular ramus height was found to be significantly larger in TS patients treated with GH compared to healthy controls and also overdeveloped in comparison to mandibular corpus length.…”

“…Since craniofacial morphology did not differ significantly between patients with various karyotypes, 2,3,7,24 all karyotypes were included in this study. Even though 45,X TS patients had more variables differing from controls than other TS karyotypes, the only significant difference found was anteroposterior position of the mandible.…”

“…[2][3][4][5][6][7] Only a few studies have evaluated GH influence on craniofacial morphology in TS patients. [24][25][26] It was noticed that after two years of GH treatment both maxilla and mandible achieved average length, 24,25 their anteroposterior position did not improve, [24][25][26] while mandible was anteriorly rotated. 24,26 Taking into consideration these findings it could be expected that craniofacial morphology in TS patients who are treated with GH has certain distinct characteristics.…”

“…[24][25][26] It was noticed that after two years of GH treatment both maxilla and mandible achieved average length, 24,25 their anteroposterior position did not improve, [24][25][26] while mandible was anteriorly rotated. 24,26 Taking into consideration these findings it could be expected that craniofacial morphology in TS patients who are treated with GH has certain distinct characteristics. Although craniofacial morphology in Turner syndrome patients is thoroughly described, data on those receiving growth hormone are still insufficient.…”