Growth hormone treatment in Turner syndrome
Dr. Iraj Iranzad; Children’s endocrinology specialist
Some recommendations for doctors
Based on the general results of experts, what is known is that early detection techniques for Turner syndrome should be improved and the following points should be considered in people with Turner syndrome: treatment or Growth Hormone It should be started when the height is less than SD-1.5 and the height growth rate is below the 25th percentile or at least at the age of 6 years. It is possible to increase the initial dose of growth hormone (0.045 mg/kg/day) up to 0.067 mg per day, but after the age of ten, the dose should be increased. Serum IGFI level should be measured and kept at SD2 level. Puberty should be established at an age when their sexual development is equal to their healthy peers and there is no need to delay it.
Oxandolone is not widely available and should not be used, but may be used as an option for girls who are diagnosed late. The dosage should be minimal. (mg/kg/day 5 percent) so as not to cause hairiness. It should also be noted that various reports with different protocols have been published from different parts of the world for the final height increase in Turner syndrome, so some still view the intervention of GH therapy in the final height increase of Turner syndrome patients conservatively.
Some problems of reported studies
Some people have been treated at older ages and the time of treatment with GH was short. Some of these problems are described below:
GH dosage in most of the reports has been lower than the dosage used in American research because this amount is 0.375 mg/kg/week. )
Some researchers have used replacement estrogen in a relatively high amount, and this not only accelerated the closing of the epiphyses, but also had a debilitating effect on the ability to increase final height. Accepting the cooperation of the elected officials with daily GH injection has sometimes not been desirable. Therefore, it seems that advancing the treatment with GH may solve many of the mentioned problems.
Treatment complications Growth hormone in Turner syndrome
In general, the treatment is excellent and harmless, but rarely the following side effects may also be observed.
- Increased intracranial pressure
- Slippage of the epiphysis of the femoral head
- Increasing scoliosis that already exists
- Otitis media
- The increase in serum lipoproteins reported in preliminary studies after GH treatment has not been confirmed in many subjects. The
- The normality of normal blood glucose levels
- Increase in insulin after and before eating (resistance to Insulin)
- Remaining HbA1C at a normal level
- Decreased insulin levels after the end of GH treatment in many patients
Beneficial effect of GH therapy in Turner syndrome
Daily treatment with GH is painful and difficult as well as expensive, but the final height of patients with Turner syndrome may be increased effectively. Early diagnosis and treatment is the basis for the greater effect of GH therapy in increasing the final height of patients with Turner syndrome. puberty It may happen spontaneously in 25% of patients and the final height in these patients is not different from the patients who have estrogen replacement therapy. Doctors should pay attention to the diagnosis of Turner’s disease in any girl who has unexplained growth failure or short stature, even if she is in the first year of life.
Treatment should start when the growth curve falls below the growth curve of normal children, and this is mostly at the age of 2 to 4 years, and they are the same patients who will eventually increase their final height, and early treatment with GH Allows substitution therapy to Estrogen It should also be done sooner. Finally, most girls with Turner syndrome will have normal growth and normal and timely sexual development.
A new review is under way to correct the treatment methods from different reports and this study will undoubtedly confirm the effective and beneficial effect of GH therapy in Turner syndrome with appropriate dosage and early onset and long duration.
Care of tertiary patients after treatment
Care of Ternary patients continues after treatment, such as solving behavioral problems and medical needs related to this syndrome will be Also, in order to improve the quality of life of these patients, a close medical team (both in America and in other countries) who have compassion and effective help and support from the Turner Syndrome Association is needed.
Read more: How to diagnose Turner syndrome