Effect of growth hormone therapy on severe short stature and skeletal deformities in a patient with combined turner syndrome and langer mesomelic dysplasia

Bina C. Shah, Ellen S. Moran, Andrew R. Zinn, John G. Pappas

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Homozygous mutation of the short stature homeobox-containing gene, SHOX, results in Langer mesomelic dysplasia (LMD). Our case presented with severe short stature and skeletal deformities with Turner syndrome (TS) and a SHOX gene abnormality due to a downstream allele deletion in her normal X chromosome. Medical literature review did not reveal similar cases that were treated with GH therapy. Method: We present an 11-yr-old with combined TS and LMD with severe short stature and skeletal deformities. She was studied for the effect of GH therapy on stature and skeletal deformities. Karyotype testing showed 45,X/46,X,idic(X). Genetic analysis of SHOX gene testing did not detect any exonic mutations. Interestingly, both alleles of the flanking marker DXYS233, a marker downstream of the 3′ end of SHOX coding sequence, were absent with resultant LMD. GH therapy in the meandose of 0.321 mg/kg/wk was administered for 4 yr (0.287, 0.355, 0.317, and 0.327 mg/kg/week in the first, second, third, and fourth years, respectively). Clinical data were reviewed. Result: The growth rates of 3.46, 3.87, 2.3, and 0.7 cm/yr were observed in the first, second, third, and fourth years of the GH therapy, respectively. There was no clinical deterioration of the skeletal deformities. Conclusion: There was a failure to achieve growth improvements with GH therapy for 4 years, but there was no worsening of the skeletal deformities. We conclude that GH therapy may not be beneficial in severe short stature due to combined TS and LMD resulting from homozygous SHOX deficiency.

Original languageEnglish (US)
Pages (from-to)5028-5033
Number of pages6
JournalJournal of Clinical Endocrinology and Metabolism
Volume94
Issue number12
DOIs
StatePublished - Dec 2009

Fingerprint

Turner Syndrome
Growth Hormone
Genes
Testing
Chromosomes
Deterioration
Therapeutics
Alleles
Mutation
Homeobox Genes
X Chromosome
Growth
Karyotype
Langer mesomelic dysplasia

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

Effect of growth hormone therapy on severe short stature and skeletal deformities in a patient with combined turner syndrome and langer mesomelic dysplasia. / Shah, Bina C.; Moran, Ellen S.; Zinn, Andrew R.; Pappas, John G.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 94, No. 12, 12.2009, p. 5028-5033.

Research output: Contribution to journalArticle

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abstract = "Background: Homozygous mutation of the short stature homeobox-containing gene, SHOX, results in Langer mesomelic dysplasia (LMD). Our case presented with severe short stature and skeletal deformities with Turner syndrome (TS) and a SHOX gene abnormality due to a downstream allele deletion in her normal X chromosome. Medical literature review did not reveal similar cases that were treated with GH therapy. Method: We present an 11-yr-old with combined TS and LMD with severe short stature and skeletal deformities. She was studied for the effect of GH therapy on stature and skeletal deformities. Karyotype testing showed 45,X/46,X,idic(X). Genetic analysis of SHOX gene testing did not detect any exonic mutations. Interestingly, both alleles of the flanking marker DXYS233, a marker downstream of the 3′ end of SHOX coding sequence, were absent with resultant LMD. GH therapy in the meandose of 0.321 mg/kg/wk was administered for 4 yr (0.287, 0.355, 0.317, and 0.327 mg/kg/week in the first, second, third, and fourth years, respectively). Clinical data were reviewed. Result: The growth rates of 3.46, 3.87, 2.3, and 0.7 cm/yr were observed in the first, second, third, and fourth years of the GH therapy, respectively. There was no clinical deterioration of the skeletal deformities. Conclusion: There was a failure to achieve growth improvements with GH therapy for 4 years, but there was no worsening of the skeletal deformities. We conclude that GH therapy may not be beneficial in severe short stature due to combined TS and LMD resulting from homozygous SHOX deficiency.",
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