Objectives: To evaluate the efficacy of growth hormone (GH) treatment in children with Turner syndrome (TS) and to analyze the factors affecting the success of treatment.
Methods: Retrospective observational study was conducted for 62 patients with TS. 3 groups of patients were identified: group 1 with karyotype 45, X (n=32), group 2 with mosaic variant 45,X/46,XX (n=8), group 3 with structural anomalies of X chromosome (n=22). All patients were treated with GH at a dose of 0.33 mg/kg per day continuously for a year or more. A retrospective analysis of height (cm, SDS), growth velocity (cm/year), change in height SDS (ΔSDS), bone age before and during treatment was carried out. The results were processed using SPSS.22.
Results: TS was diagnosed in patients with characteristic phenotypic signs according to the results of karyotyping at the age of 6.7±5.07 (0.117.3) years. The chronological age at the start of GH treatment was 9.1±3.5 years (2.615.2). Most of the children had significant growth retardation (height SDS −2.87±0.93) and a low growth velocity (4.7±1.3 cm/year). Growth velocity increased with the use of GH in the first year of treatment. In group 1 the growth velocity was 7.2 [6.0; 9.5] cm/year versus 4.4 [3.48; 5.27] cm/year before treatment (P<0.001), in group 2 - 6.38 [6.1; 8.56] cm/year versus 3.95 [2.82; 5.42] cm/year (P=0.004) and in group 38.15 [7.02; 9.72] cm/year versus 5.05 [3.9; 6.1] cm/year (P<0.001). Height ΔSDS for 1 year of therapy was 0.49±0.3. The maximum change in height SDS were observed in girls with TS due to structural anomalies of the X chromosome (ΔSDS=0.55 [0.29; 0.72]), lower - in patients with monosomy X (ΔSDS=0.43 [0.23; 0.71]). To assess the effect of the age at initiation of therapy on the efficacy of treatment, groups of patients have been identified: up to 5 years, from 5 to 13 years, after 13 years. There was a small increase in bone age after GH therapy for 12 months in children under 5 years of age (0.5 years [0.5; 0.94]) versus 1.25 years [0.96; 2.0] in children older than 5 years (P=0.021) and 1.0 years [0.56;1,74] in children over 13 years old. This may worsen the growth prognosis with long-term GH treatment, given the lower baseline growth rates in TS children over the 5 years old.
Conclusions: For TS patients, GH treatment significantly increases growth rate. The age at initiation of therapy is an important prognostic factor.
18 - 21 May 2019
European Society of Endocrinology