Long-term effects of growth hormone on body composition and metabolic  parameters in girls with Turner syndrome

Introduction
Patients with Turner syndrome (TS) are at increased risk of metabolic complications, partly as a consequence of truncal obesity, which can already appear in childhood. Growth hormone (GH) therapy is widely used in this population and is known to exert a beneficial effect on body composition (BC). The study aims to evaluate the impact of GH therapy on BC and explore associations between BC parameters and components of metabolic syndrome in girls with TS during a 5-year follow-up.

Material and methods
Twenty-one TS patients were enrolled. Auxological, BC, and biochemical parameters were assessed at baseline (V1), after 3 years (V3), and after 5 years (V5) of GH therapy. Results were available for 21, 20, and 13 patients, respectively. Biochemical phenotypes were determined using carbohydrate and lipid parameters.

Results
The only BC parameter that significantly increased during GH therapy was fat-free mass (FFM). Along with rising insulin-like growth factor 1 levels, fasting and postprandial insulin concentrations, as well as insulin resistance, increased during treatment. Total cholesterol decreased, although without significant changes in its fractions. No significant correlations were found between BC parameters, glucose, and total cholesterol during the GH 5-year follow-up.

Conclusions
Growth hormone therapy exerts a beneficial effect on BC in girls with TS, reflected by an increase in FFM. However, carbohydrate metabolism should be closely monitored, in line with national program requirements, due to the increased insulin resistance during GH therapy. Lifestyle recommendations promoting healthy behaviors should be provided to all patients with TS.