Seasonal Variation in Growth Rate of Children Treated With Biosynthetic Growth Hormone

Abstract

PA arld DEB/NICHD/NIH, Bethesda. MD. USA. G~rls with Turner syndrome (TS) are short and lack endogenous estrogen. Our aim in this study was t o evaluate the behavioral effects of continuous growth hormone (GH), ethinyl estradiol (E), or placebo (P) treatment in TS girk. Subjects were recruited from an ongoing randomized trial, consisting of 4 TS treatment groups: l.E (25-50 ng/kg/day until age 12,100 ng/kg, ages 12-14, 200-800 ng/kg/day above 1 4 ), 2. GH (0.1 mg/kg, SQ tiw). 3. E, as above, plus GH, and 4. P until age 12, followed by E, as above. The psychological assessment (at baseline and ycy& intervals) included 2 tests: The Child Behavior Checklist (CBCL), a parental report of social and behavior problems, and the Piers-Harris Self-concept Scale (child reported), a test of overall self-concept. Results were analyzed from 106 girls with TS, ages 5-16 years, with treatment durations of 0-5 years. Basellne karyotype, age. SES level,and growth rate were simllar in all 4 groups. Multiple regressions explored the association between treatment group, duration, and the psychological measures for TS girls treated early (prior t o age 11.5) or late (after age 11.5). In the early-treated girls,no associations between type or duration of treatment and the psychological measures were revealed. In the late-treated girls,longer E treatment was associated with improved ratings on the Piers Total self-concept scale (p-.0001). Longer GH treatment was associated with more positive ratings on the intellectual and physical subscales (p=.0001). On the CBCL.longer GH treatment was associated with decreased, negative Internalizing and Externallzing (p=.004) behaviors and improved school functioning (p=.0001). We conclude: (1) for early-treated TS girls.treatment with E.GH,or P had no significant effects on the behavioral variables and (2) for late-treated TS girls,both E and GH treatment was associated with improved behavioral outcomes. a n o r e x i a n e r i o s a , o b e s i t y , d i a b e t e s , ~H -t h e r a~y ; a c r o m e g a l y a n d c i r r h o s i s . I n s h o r t , s l o w l y g r o w l n g c h i l d r e n GH-BP c o r r e l a t e d n e g a t i v e l y w i t h m e a n G H -p u l s e a m p l i t u d e a n d i n t e g r a t e d c o n c e n t r a t i o n . GH p u l s a t i l i t y i s h i g h i n n e w b o r n s , f a s t i n g , a n o r e x i a n e r v o s a d i a b e t e s a c r o m e g a l y a n d c i r r h o s i s .GH-BP i s l o w i n ' a l l , t h e s & conditions. GH p u l s a t j l i t y i s l o w , a n d GH-BP i s h i g h , I n G H -t h e r a p y a n d o b e s l t y . N e g a t i v e correlation o E GH p u 1 s a t ; i l l t y w i t h G H -B P , e x i s t s a c r o s s , t h e m a m m a l i a n c l a s s w l t h i n c r e a s i n g p u l s a t l l l t y i n r a b b i t < man < E e m a l e r a t < m a l e r a t < g u i n e a p l g , , w h e r e a s GH-BP l e v e l s a n d l i v e r m e m b r a n e ' s GH-R d e c r e a s e I n t h e same o r d e r . N e w b o r n r a t s h a v e h i g h GH p u l s a t i l i t y a ...