Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Pediatrics

Background: Growth hormone (GH) may positively affect body composition and body mass index in patients with Turner syndrome (TS). The study aims to compare blood pressure, lipid profile, fasting blood glucose, insulin resistance, waist circumference (WC) and cardiac functions between TS patients before and after GH therapy. Methods: The study included 54 TS patients; 29 after beginning GH therapy (cases) and 25 before initiating GH therapy (serving as controls). Their ages ranged from 6.01 years to 17.1 years. Anthropometric measures, skin fold thickness measurements, body composition analysis and blood pressure were recorded. Fasting lipid profile, fasting blood glucose, fasting insulin, fasting c-peptide, liver enzymes and thyroid profile were studied. Complete two-dimensional, M-mode, pulsed-wave Doppler echocardiography, pulsed-wave tissue Doppler imaging (TDI) and abdomino-pelvic ultrasound were done. Results: Cases had higher WC SDS for age, hip circumference, bone mass, high density lipoprotein cholesterol (HDL-C), myocardial performance index of left and right ventricles and S' wave in the septal wall of left ventricle (reflecting global impairment of myocardial function). One patient who had received GH and two controls fulfilled international diabetes feredration criteria of metabolic syndrome. The patients' age at start of GH therapy correlated negatively with height SDS for age and muscle percentage and positively with triglyceride levels.The cholesterol levels correlated positively with diastolic blood pressure percentiles. Insulin resistance was positively correlated with WC SDS and sum of skin fold thickness percentiles. Fasting c- peptide level was positively correlated with systolic blood pressure percentiles

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