ESPE2023 Poster Category 1 Growth and Syndromes (75 abstracts)
Changes in carbohydrate and lipid metabolism during 10-year follow-up of patients with Turner syndrome treated with growth hormone.
Ewa Błaszczyk 1 , Anna-Mariia Shulhai 2 , Joanna Gieburowska 1 & Aneta Gawlik 1
1Department of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland. 2I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
Background: Disorders in carbohydrate and lipid metabolism are more common in girls with Turner syndrome (TS) than in general population. Metabolic disorders have been identified as risk factors for the development of cardiovascular diseases. Additionally, TS patients are usually treated many years with growth hormone (GH) that affects the parameters of carbohydrate-lipid metabolism. Therefore cardiovascular risk factors should be monitored in TS girls.
Objective: To establish changes in carbohydrate and lipid parameters from the beginning of GH treatment through the subsequent years of therapy.
Patients and Method: Clinical and laboratory data was available for 89 TS patients at the beginning of GH therapy (V0) and after 1st(V1), 3rd (V3), 5th (V5) and 10th (V10) year of GH therapy for 60, 76, 50 and 22 patients, respectively. The patient’s biochemical phenotypes were determined by glucose and insulin in OGTT (0’&120’), HOMA-IR, Ins/Glu (0’) ratio, HDL-cholesterol and triglycerides (TG) concentration.
Results: BMI z-score V5 and V10 were higher to BMI Z-score V0 (pV0-V5=0.043, pV0-V10=0.023). Prediabetes was diagnosed at V0 point – in 3.4%, V1 - 6.7%, V3 - 6 7.9%, V5 - 8.0%, V10 - 9.1%. No patient met diagnostic criteria for diabetes. Changes in carbohydrate metabolism are presented in the Table. No statistically significant difference in the serum TG and HDL-cholesterol level during GH therapy were found.
| Duration of GH therapy | P-value | |||||
| V0 n=89 | V1 n=60 | V3 n=76 | V5 n=50 | V10 n=22 | ||
| Glucose mg/dl | 85.0 (78.0; 90.0) | 91.0 (84.0; 98.0) | 88.50(81.0; 95.8) | 90.5 (84.5; 97.3) | 85.5 (81.5; 95.5) | pV0-V1<0.001 pV0-V3=0.006 pV0-V5<0.001 pV0-V10=NS |
| Glucose 120’, mg/dl | 110.0 (89.0; 122.0) | 119.4 (99.5; 139.8) | 111.0 (100.0; 130.0) | 107.9 (98.5; 126.0) | 102.5 (93.3; 125.0) | pV0-V1=0.034 рV0-V3=NS pV0-V5=NS pV0-V10=0.046 |
| Insulin 0’, mIU/L | 6.00 (3.0; 9.0) | 14.5 (6.5; 78.5) | 10.3 (7.0; 14.6) | 13.0 (9.0; 17.1) | 13.2 (9.8; 19.4) | pV0-V1=0.035 рV0-V3=0.011 pV0-V5=0.007 pV0-V10=0.008 |
| Insulin 120’, mIU/L | 34.8 (14.0; 59.0) | 37.0 (22.3; 74.8) | 56.9 (35.0; 70.7) | 59.0 (32.1; 84.2) | 68.3 (46.1; 121.0) | pV0-V1=NS рV0-V3=0.001 pV0-V5=0.001 pV0-V10=0.001 |
| HOMA-IR | 0.94 (0.42; 1.44) | 2.22 (1.36; 3.59) | 2.03 (1.30; 3.07) | 2.36 (1.61; 3.10) | 2.44 (1.87; 3.08) | pV0-V1<0.001 рV0-V3<0.001 рV0-V5=0.001 pV0-V10<0.001 |
| Ins/Glu | 0.05 (0.02; 0.07) | 0.12 (0.06; 0.15) | 0.12 (0.08; 0.16) | 0.11 (0.08; 0.17) | 0.16 (0.11; 0.21) | pV0-V1=0.003 рV0-V3<0.001 рV0-V5<0.001 pV0-V10<0.001 |
Conclusion: Monitoring the basic parameters of carbohydrate-lipid metabolism in girls with TS seems to be particularly important. Our study confirmed the development of reversible insulin and carbohydrate metabolism impairment during GH therapy in girls with TS.
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