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Al ADK, Şükür NM, Özturan EK, Öztürk AP, Poyrazoğlu Ş, Baş F, Darendeliler FF. Body proportions in patients with Turner syndrome on growth hormone treatment. Turk J Med Sci 2023; 53:518-525. [PMID: 37476877 PMCID: PMC10388058 DOI: 10.55730/1300-0144.5612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/28/2022] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND : In this cross-sectional study, we aimed to evaluate auxological measurements and detailed body proportions of recombinant human growth hormone (GH)-treated patients with Turner syndrome (TS) and compare them with a group of healthy females. METHODS We evaluated 42 patients with TS who received GH treatment and 20 healthy controls. Anthropometric measurements were taken and target height, body mass index (BMI), arm span-height difference, extremity-to-trunk ratio, and Manouvrier's skelic index were calculated. RESULTS : The median (min-max) age of the patients at the time of evaluation was 13.6 (4.3-20.7) years, and the control group was 12.9 (3.8-23.7) years. Height, sitting height, and arm span of TS patients were significantly lower than those of the control group. Sitting height/height ratio (SHR) was in normal ranges in both groups and BMI was significantly higher in TS patients when compared to the control group. According to Manouvrier's skelic index, TS patients had shorter legs than the control group (p = 0.001). The extremity-trunk ratio was significantly decreased in TS patients compared to healthy controls (p < 0.001). There was no significant difference between the karyotype groups in terms of these indexes. DISCUSSION TS patients had short stature, increased BMI and waist circumference, normal head circumference, and decreased extremity-trunk ratio. Sitting height and leg length were short; however, the SHR standard deviation score (SDS) was in the normal range. Despite being treated with GH, TS patients had disproportionate short stature. The disproportion in TS patients was similar to short-stature homeobox-containing gene (SHOX) deficiency, which is considered to be SHOX haploinsufficiency in the etiopathogenesis of short stature.
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Affiliation(s)
- Aslı Derya Kardelen Al
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Turkey ; Department of Pediatric Endocrinology, Child Health Institute, Istanbul University, İstanbul, Turkey
| | - Nur Mine Şükür
- Department of Pediatric Endocrinology, Child Health Institute, Istanbul University, İstanbul, Turkey
| | - Esin Karakılıç Özturan
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Ayşe Pınar Öztürk
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Şükran Poyrazoğlu
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Firdevs Baş
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Fatma Feyza Darendeliler
- Department of Pediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Turkey
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Stoklasova J, Kaprova J, Trkova M, Nedomova V, Zemkova D, Matyskova J, Soucek O, Sumnik Z, Lebl J. A Rare Variant of Turner Syndrome in Four Sequential Generations: Effect of the Interplay of Growth Hormone Treatment and Estrogens on Body Proportion. Horm Res Paediatr 2017; 86:349-356. [PMID: 27459301 DOI: 10.1159/000448097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/30/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Terminal Xp deletion leads to SHOX haploinsufficiency, and when it exceeds Xp22.33 it causes a variant of Turner syndrome (TS) in which gonadal function is preserved and short stature constitutes the major clinical feature. CASE REPORT We present a family with vertical transmission of TS that affected six women in four sequential generations. The karyotype was defined as a combination of terminal Xp deletion and terminal Xq duplication: 46,X,rec(X)inv(p21.1q27.3). All affected women had short stature, but had developed spontaneous puberty and normal fertility. Generation IV exclusively received recombinant human growth hormone (rhGH). We investigated the effect of rhGH treatment on skeletal growth and body proportion via the comparison of auxological data from an untreated 39.7-year-old mother to her 14.8-year-old rhGH-treated daughter. The adult height of the daughter was substantially better than that of the mother [160.3 cm (-0.8 SDS) and 150.0 cm (-2.7 SDS), respectively]; however, the disproportion progressed following rhGH treatment and ultimately led to a worse trunk-to-extremities ratio compared with the mother (4.8 and 3.7 SDS, respectively). CONCLUSION This rare family confirms the vertical transmission of TS spanning multiple generations. The combination of endogenous estrogen production and exogenous rhGH administration in women with SHOX haploinsufficiency may worsen their body disproportion.
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Affiliation(s)
- Judith Stoklasova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, and GENNET, Prague, Czech Republic
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Tsuji M, Ayabe T, Tanaka R, Senju A, Shibata E, Araki S, Morokuma S, Sanefuji M, Kusuhara K, Kawamoto T. Comparative study on three different methods for arm-span measurement: the Japan environment and Children's study pilot. Environ Health Prev Med 2017; 22:28. [PMID: 29165129 PMCID: PMC5664793 DOI: 10.1186/s12199-017-0632-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Arm span is an important measure for the assessment of growth and hormone deficiency diseases. In an epidemiological survey, with a large number of subjects' indicators, it is especially valuable to establish methods which can measure both quickly and accurately. However, there are various methods, and the length of arm span may vary according to the medical institution. METHODS The arm span of nine 6-year old subjects was measured using two institutional standard methods, A and B, and a third method C which is an improved method and has been used for the first time in this study. A, No-Wall, with heels together the child stretches the arms out to the sides. B, Wall & No-Line, the child stands against the wall with heels together and spreads the arms against the wall. C, Wall & Line, the method is the same as B except a paper with horizontal lines is placed on the wall. We measured twice by each method. RESULTS The difference between the 1st and 2nd measurements was marginally significantly smaller by using method of C. CONCLUSION The method C, which we improved, is the best way to measure arm span.
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Affiliation(s)
- Mayumi Tsuji
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan.
| | - Tadayuki Ayabe
- Medical Support Center for Japan Environment and Children's Study (JECS), National Center for Child Health and Development, Tokyo, Japan
| | - Rie Tanaka
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan
| | - Ayako Senju
- Regional Center for Japan Environment and Children's Study (JECS), University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Eiji Shibata
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shunsuke Araki
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Seiichi Morokuma
- Regional Centre for Japan Environment & Children's Pilot Study, Kyushu University, Fukuoka, Japan
| | - Masafumi Sanefuji
- Regional Centre for Japan Environment & Children's Pilot Study, Kyushu University, Fukuoka, Japan
| | - Koichi Kusuhara
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Toshihiro Kawamoto
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan
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Gawlik A, Malecka-Tendera E. Transitions in endocrinology: treatment of Turner's syndrome during transition. Eur J Endocrinol 2014; 170:R57-74. [PMID: 24225028 DOI: 10.1530/eje-13-0900] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Transition in health care for young patients with Turner's syndrome (TS) should be perceived as a staged but uninterrupted process starting in adolescence and moving into adulthood. As a condition associated with high risk of short stature, cardiovascular diseases, ovarian failure, hearing loss and hypothyroidism, TS requires the attention of a multidisciplinary team. In this review paper, we systematically searched the relevant literature from the last decade to discuss the array of problems faced by TS patients and to outline their optimal management during the time of transfer to adult service. The literature search identified 233 potentially relevant articles of which 114 were analysed. The analysis confirmed that all medical problems present during childhood should also be followed in adult life. Additionally, screening for hypertension, diabetes mellitus, dyslipidaemia, and osteoporosis is needed. After discharge from the paediatric clinic, there is still a long way to go.
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Affiliation(s)
- Aneta Gawlik
- Department of Paediatrics, Paediatric Endocrinology and Diabetes, Medical University of Silesia, ul Medykow 16, 40-752 Katowice, Poland
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El-Bassyouni HT, Afifi HH, Aglan MS, Mahmoud WM, Zaki ME. Growth curves of Egyptian patients with Turner syndrome. Am J Med Genet A 2012; 158A:2687-91. [PMID: 22847945 DOI: 10.1002/ajmg.a.35518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 05/13/2012] [Indexed: 11/12/2022]
Abstract
This study analyzes the body anthropometric measurements in females with Turner syndrome (TS) not treated with recombinant human growth hormone. Height, weight, head circumference, and body mass index (BMI) data were collected from 93 patients. Their ages ranged from 6 months to 24 years (mean 10 ± 4.3 years). Chromosomal analysis revealed: 55 patients with 45,X and 38 patients with mosaic karyotypes. Patients were divided into yearly age groups. Standard growth curves were constructed for these Egyptian Turner syndrome (TS) patients. Mean and standard deviations were estimated across the age groups. When comparing the mean heights of patients to the Egyptian standards, short stature (≤2 SD) was found in 96.8% of patients older than 6 years. Patients' mean weight and BMI were higher than controls. The mean height of the studied Egyptian patients was slightly lower than that of females with TS in UK and European patients. Therefore, local reference values are more appropriate than International standards. The charts presented here can be used to optimize routine healthcare for Egyptian TS patients. The use of growth charts specific for Egyptian TS patients can help to discover early physical developmental delay and suggests the necessity of looking for concomitant diseases affecting growth.
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Baldin AD, Fabbri T, Siviero-Miachon AA, Spinola-Castro AM, de Lemos-Marini SHV, Baptista MTM, D'Souza-Li LFR, Maciel-Guerra AT, Guerra-Junior G. Growth hormone effect on body composition in Turner syndrome. Endocrine 2011; 40:486-91. [PMID: 21720878 DOI: 10.1007/s12020-011-9504-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 06/17/2011] [Indexed: 10/18/2022]
Abstract
This study analyzes the body composition of young adult women with Turner syndrome (TS) either treated or not treated with recombinant human growth hormone (rhGH) and compares them with a group of healthy women. Fifty-two non-treated TS patients (23.0 ± 5.8 years), 30 treated with rhGH (21.5 ± 1.5 years), and 133 healthy young adult women (22.9 ± 3.2 years) were evaluated regarding height (H) and weight, body mass index (BMI), brachial perimeter and tricipital cutaneous fold (fat and lean areas at the arm), sitting height (SRH = sitting height/H × 100), leg length (leg/H), waist and hip circumferences (waist/hip), and bioimpedance (percentages of water, lean mass, and fat mass). Age at start of rhGH therapy varied from 7.8 to 15.1 years (10.0 ± 1.3 years), duration of treatment from 2.8 to 8.2 years (3.7 ± 1.5 years), and the mean dose was 0.42 mg/kg/w (from 0.32 to 0.50 mg/kg/w). Body composition (except height) did not differ between TS groups, but there were differences when compared to the control group: weight and sitting height were lower in TS patients; and BMI, SHR, and leg/H were higher. There was an association between all groups with regards to BMI, waist, SHR, and leg/H, but not in percentage of fat mass. SHR was positively correlated with BMI, waist, hip, and percentage of fat mass. This sample of TS patients (with and without rhGH therapy) did not differ in BMI or body composition. However, there were differences between patients with TS patients and normal healthy women. Regardless of rhGH therapy, TS patients should be monitored, particularly for sitting height, SHR, leg length, leg/H, and waist/hip.
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Affiliation(s)
- Alexandre Duarte Baldin
- Pediatric Endocrinology Unit, Department of Pediatrics and Center for Investigation in Pediatrics, Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), Campinas, SP, 13083-970, Brazil
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