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Front. Endocrinol. | doi: 10.3389/fendo.2018.00054

Secular trends on birth parameters, growth and pubertal timing in girls with Turner syndrome

 Joachim F. Woelfle1*, Anders Lindberg2,  Ferah Aydin2,  Ken Ong3, Cecilia Camacho-Hubner4 and Bettina Gohlke1
  • 1Pediatric Endocrinology Division, University of Bonn, Germany
  • 2Endocrine Care, Pfizer (Sweden), Sweden
  • 3Institute of Metabolic Sciences, MRC Epidemiology Unit (MRC),University of Cambridge, United Kingdom
  • 4Endocrine Care, Pfizer (United States), United States

Background: Whether children with chromosomal disorders of growth and puberty are affected by secular trends (STs) as observed in the general population remains unanswered, but this question has relevance for expectations of spontaneous development and treatment responses.
Objectives: To study STs in birth parameters, growth and pubertal development in girls with Turner syndrome (TS).
Study design: Retrospective analysis of KIGS data (Pfizer International Growth Database). We included all TS patients who entered KIGS between 1987 and 2012 and were born 1975 to 2004, who were pre-pubertal and growth-treatment naïve at first entry (total number: 7219). Pre-treatment height and ages at treatment start were compared across 5-year birthyear groups, with sub-group analyses stratified by induced or spontaneous puberty start.
Results: We observed significant STs across the birthyear groups for birth weight (+0.18 SDS, p<0.001), pre-treatment height at mean age 8 years (+0.73 SDS, p<0.001), height at start of GH-therapy (+0.38 SDS, p<0.001) and start of puberty (+0.42 SDS, p<0.001). Spontaneous puberty onset increased from 15% to 30% (p<0.001). Mean age at GH treatment start decreased from 10.8 to 7.4 years (-3.4 years; p<0.001), substantial declines were seen in ages at onset of spontaneous and induced puberty (-2.0 years; p<0.001) and menarche (-2.1 years; p<0.001).
Conclusion: Environmental changes leading to increased height and earlier, and also more common, spontaneous puberty are applicable in TS as in normal girls. In addition, greater awareness for TS may underlie trends to earlier start of GH therapy and induction of puberty at a more physiological age.

Keywords: Turner Syndrome, height, Growth, Birth Weight, birth length, Puberty, Secular trend

Received: 01 Dec 2017; Accepted: 05 Feb 2018.

Edited by:

Ahmet Uçar, University of Health Sciences, Şişli Hamidiye Etfal Education and Research Hospital, Turkey

Reviewed by:

Andrew Whatmore, University of Manchester, United Kingdom
Ayhan Abacı, Faculty of Medicine, Dokuz Eylül University, Turkey  

Copyright: © 2018 Woelfle, Lindberg, Aydin, Ong, Camacho-Hubner and Gohlke. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Joachim F. Woelfle, University of Bonn, Pediatric Endocrinology Division, Adenauerallee 119, Bonn, 53115, Germany,