Body proportions during long-term growth hormone treatment in girls with Turner syndrome participating in a randomized dose-response trial

To assess body proportions in girls with Turner syndrome (TS) during long t erm GH treatment, height, sitting height (SH), hand (Hand) and foot (Foot) lengths, and biacromial (Biac) and biiliacal (Biil) diameters were measured in 68 girls with TS participating in a GH dose-response trial. These previ ously untreated girls with TS, aged 2-11 yr, were randomly assigned to 1 of 3 GH dosage groups: group A, 4 IU/m(2).day; group B, first year 4 and ther eafter 6 IU/m(2).day; group C, first year 4, second year 6, and thereafter 8 IU/m(2).day. Seven-year data were evaluated to assess the effect of GH tr eatment on body proportions during childhood. In addition, data from all gi rls who had reached adult height were evaluated to determine the effect on the adult body proportions. All results were adjusted for age and sex and e xpressed as so scores using reference Values of healthy Dutch girls. To des cribe the proportions of SH, Hand, Foot, Biac, and Bill to height, these va lues were adjusted for the so score of height and mere expressed as shape v alues, using the formula, e.g. for SH: shape SH = (SH SD score - height so score)/root(2 - 2 x correlation coefficient between SH and height in the re ference population). Furthermore, so scores using references of untreated g irls with TS were calculated for height and SH. Values less than -2 or more than +2 were considered outside the normal range. At baseline, the shape values of all measurements were significantly higher than zero, but most mean shape values were still within the normal range. Seven-year data of 64 girls and adult height data of 32 girls showed that a n increase in height was accompanied by an even higher increase in Foot, re sulting in mean so scores above zero and shape values of +2 and higher. The increase in the shape value of Foot was significantly higher in groups B a nd C compared to that in group A after 7 yr of GH treatment, but there were no significant differences between the GH dosage groups in the girls who h ad reached adult height. The shape values of SH had decreased to values clo ser to zero after reaching adult height, especially in group A. A similar p attern in the relationship of SH to height was seen using references of gir ls with TS. No significant changes in the other proportions were found afte r reaching adult height. In conclusion, on the average, untreated girls with TS have relatively larg e trunk, hands, and feet, and broad shoulders and pelvis compared to height . The increase in height after long term GH treatment is accompanied by an even higher increase in Foot and a moderate improvement of the disproportio n between height and SH. Recently published reference data from untreated a dults with TS and the results of a different patient group receiving a comp arable GH dosage suggest that the disproportionate growth of feet has to he considered a part of the natural development in TS, but might be influence d by higher GH dosages. The development of large feet can play a role in th e decision of the girl to discontinue GH treatment in the last phase of gro wth.