Effect of growth hormone and 17beta-oestradiol treatment on metabolism and body composition in girls with Turner syndrome.
OBJECTIVE
Girls with Turner syndrome (TS) receive GH treatment during childhood, and in adolescence this treatment may be combined with oestradiol. We have studied the effects of this combined treatment on metabolism and body composition.


METHODS
We performed a double-blind, placebo-controlled, randomized, crossover study. All girls with TS (n = 8, 16 +/- 2 years) were treated with placebo + placebo, GH + placebo or GH + 17beta-oestradiol for 2 months, and were studied at the end of each period. Controls (n = 10, 14 +/- 2 years) were studied once without treatment. Twenty-four-hour sampling of oestradiol, growth factors, insulin, glucose, lipolytic and gluconeogenic precursors was performed, followed by an oral glucose tolerance test (OGTT) and assessment of body composition and mineral content.


RESULTS
GH induced insulin resistance, which was not aggravated further by concomitant oestradiol treatment. The 24-h integrated serum 17beta-oestradiol was reduced compared to controls (0.58 +/- 0.32 vs. 2.81 +/- 2.78 nmol/l/24 h, P = 0.032), but increased during GH + oestrogen (E2) treatment without reaching control levels, while GH + placebo caused a further reduction (anova, P = 0.008). Total fat mass was increased in girls with TS compared with controls (P = 0.009), while lean body mass (P = 0.02) and bone mineral content (P = 0.04) was decreased, with specific regional characteristics in body composition.


CONCLUSIONS
GH treatment induces insulin resistance and changes in body composition in TS, which is not further compromised by concomitant oestradiol treatment. Body composition is changed in TS, with specific regional changes, in comparison with controls. Integrated 24-h oestradiol is low in TS, and is only partially restored during treatment with standard doses of 17beta-oestradiol.
Gravholt
Claus Højbjerg
CH
Medical Department M (Endocrinology and Diabetes) and Medical Research Laboratories, Aarhus Sygehus, Aarhus University Hospital, Aarhus C, Denmark. ch.gravholt@dadlnet.dk
Hjerrild
Britta Eilersen
BE
Naeraa
Rune Weis
RW
Engbaek
Frode
F
Mosekilde
Leif
L
Christiansen
Jens Sandahl
JS
D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D001823:Body Composition / Q000187:drug effects; D015519:Bone Density / Q000187:drug effects; D016022:Case-Control Studies; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004958:Estradiol / Q000097:blood / Q000627:therapeutic use*; D005260:Female; D005934:Glucagon / Q000097:blood; D005951:Glucose Tolerance Test; D013006:Growth Hormone / Q000097:blood / Q000627:therapeutic use*; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D018970:Insulin-Like Growth Factor Binding Protein 1 / Q000097:blood; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008055:Lipids / Q000097:blood; D014424:Turner Syndrome / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology
D001786:Blood Glucose; D007328:Insulin; D018970:Insulin-Like Growth Factor Binding Protein 1; D018972:Insulin-Like Growth Factor Binding Protein 3; D008055:Lipids; D004958:Estradiol; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; D005934:Glucagon