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Reduced Abdominal Adiposity and Improved Glucose Tolerance in Growth Hormone-Treated Girls with Turner Syndrome

Developmental Endocrinology Branch, National Institute of Child Health and Human Development (NICHD) (N.W., V.K.B., C.A.B.) and National Institutes of Health (NIH) Clinical Center Radiology (S.H.), NIH, Bethesda, Maryland 20892

Address all correspondence and requests for reprints to: Carolyn Bondy, M.D., Developmental Endocrinology Branch, NICHD, NIH, Bethesda, Maryland 20892. E-mail: bondyc{at}mail.nih.gov.

Background: Individuals with Turner syndrome (TS) are at increased risk for impaired glucose tolerance and diabetes mellitus. It is unknown whether pharmacological GH treatment commonly used to treat short stature in TS alters this risk.

Objective: Our objective was to compare adiposity and glucose tolerance in GH-treated vs. untreated girls with TS.

Methods: In a cross sectional study, GH-treated girls with TS (n = 76; age 13.6 ± 3.7 yr) were compared to girls with TS that never received GH (n = 26; age 13.8 ± 3.5 yr). Protocol studies took place in the NIH Clinical Research Center from 2001–2006 and included oral glucose tolerance tests, body composition analysis by dual-energy x-ray absorptiometry, and abdominal fat quantification by magnetic resonance imaging. GH was not given during testing.

Results: Total body fat (35 ± 8 vs. 28 ± 8%, P < 0.0001), sc abdominal fat (183 vs. 100 ml, P = 0.001), and intraabdominal fat (50 vs. 33 ml, P < 0.0001) were significantly greater in untreated girls. Fasting glucose and insulin were similar, but the response to oral glucose was significantly impaired in the untreated group (28 vs. 7% with impaired glucose tolerance, P = 0.006). A specific excess of visceral fat and insulin resistance was apparent only in postpubertal girls that had never received GH. GH-treated girls demonstrated lower adiposity compared with untreated girls for an average of 2 yr after discontinuation of GH.

Conclusions: Abdominal adiposity is significantly lower and glucose tolerance significantly better in GH-treated vs. untreated girls with TS, suggesting that beneficial effects upon body composition and regional fat deposition outweigh transient insulin antagonism associated with GH administration.