[Carbohydrate metabolism in patients with Turner syndrome. The effect of therapy with growth hormone, oxandrolone and a combination of both].
Insulin resistance or the impairment of insulin capability to decrease blood glucose levels is seen in approximately 25% of girls with Turner syndrome (TS). Growth hormone (hGH), especially when administered at pharmacological doses, may additionally negatively affect the carbohydrate metabolism in TS girls, changing the response of peripheral tissues to insulin. The aim of the report was the assessment of glucose and insulin release and the prevalence of insulin resistance in physiological conditions (baseline and post-standard meal values), as well as after oral and IV glucose tolerance test in patients with Turner syndrome after a 6-month therapy with growth hormone, oxandrolone (Ox) and a combination of these two agents (hGH+Ox). The authors also evaluated the effect of these three therapeutic methods on carbohydrate metabolism, attempting to define the risk of glucose intolerance, type 2 diabetes and hyperinsulinemia and insulin resistance. The analysis of individual results in all the patients revealed that laboratory criteria for diagnosis type 2 diabetes (glycemia at 120 min OGTT >12.2 mmol/l) were met by one patient subjected to a combined therapy. Glucose intolerance (IGT) in OGTT, normally seen in 12.5% of untreated girls, was not intensified following a 6-month hGH or Ox therapy, but was more pronounced in patients on the combined treatment. A tendency was seen towards fasting hyperinsulinism (>25 uLI/ml) in patients on hGH and hGH+Ox, with more pronounced insulin resistance (IR1<7, IR2>5) in girls on the combined therapy.


CONCLUSIONS
Combined treatment with growth hormone and oxandrolone results in a significant increase of insulin secretion and increased insulin resistance. In view of the effects of insulin resistance, one should analyze the advisability of combined treatment with growth hormone and oxandrolone in girls with Turner syndrome.
Starzyk
Jerzy
J
Klinika Endokrynologii Dieci i Młodziezy Katedry Pediatrii, Collegium Medicum UJ w Krakowie, Kraków. mistarzy@cyf-kr.edu.pl
D000293:Adolescent; D045930:Anabolic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001786:Blood Glucose / Q000378:metabolism; D050260:Carbohydrate Metabolism; D002648:Child; D002675:Child, Preschool; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced; D004359:Drug Therapy, Combination; D005260:Female; D019382:Human Growth Hormone / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006946:Hyperinsulinism / Q000139:chemically induced; D007333:Insulin Resistance; D010074:Oxandrolone / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome; D014424:Turner Syndrome / Q000188:drug therapy* / Q000378:metabolism*
D045930:Anabolic Agents; D001786:Blood Glucose; D019382:Human Growth Hormone; D010074:Oxandrolone