Carbohydrate and lipid metabolism during various growth hormone dosing regimens in girls with Turner syndrome. Dutch Working Group on Growth Hormone.

To analyze the effects of supraphysiological dosages of growth hormone (GH) on carbohydrate (CH) and lipid metabolism, we investigated 87 girls with Turner syndrome (TS) in two studies: (1) a 4-year GH dose-response (DR) study comparing three groups with stepwise GH dosage increases up to 8 IU/m2/d in girls aged 2 to 11 years, and (2) a 2-year GH administration frequency-response (FR) study in girls aged 11 to 17 years, comparing once-daily (OD) and twice-daily (BID) injections of a total GH dose of 6 IU/m2/d in combination with low-dose ethinyl estradiol (50 ng/kg/d orally). At baseline, impaired glucose tolerance (IGT) was present in 6% of the girls, and at the end of the studies, in 5%. In the DR study, the area under the curve for time-concentration (AUCab) for glucose after an oral glucose tolerance test (OGTT) showed no change over time and no significant difference between any of the study groups. However, in all three DR groups, the AUCab for insulin, fasting glucose, the insulinogenic index, hemoglobin A1c (HbA1c), and urinary C-peptide (uCp) were all significantly higher after 4 years compared with pretreatment (P<.05). In the FR study, group differences were not observed. Compared with healthy Dutch control subjects, the median baseline levels in relatively young girls in the DR study were similar for total cholesterol (TC) and lower for high-density lipoprotein (HDL) cholesterol. In contrast, the median TC levels of relatively older girls in the FR study were higher and HDL levels were similar. With increasing GH dosage in the DR study, median TC and low-density lipoprotein (LDL) levels decreased, whereas median HDL levels increased. The changes after 4 years were significant, including a decrease in the atherogenic index. GH treatment at the supraphysiological dosages used in this study did not increase the frequency of IGT or clinical diabetes. However, we observed an increased insulinogenic index indicative of insulin resistance. Therefore, long-term follow-up study is warranted in these otherwise healthy subjects. OD injection regimens changed the lipid profile toward a more cardioprotective direction with a significant reduction of the TC/HDL cholesterol ratio.