This Article Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sartorio, A. Articles by Molinari, E. Search for Related Content PubMed Articles by Sartorio, A. Articles by Molinari, E.

Different Effects of GH Treatment on Cognitive Function in Girls with Turner’s Syndrome and in Adults with GH Deficiency^a

Istituto Auxologico Italiano, IRCCS Milan, Italy

We read with great interest the paper by Ross et al. (1), concerning the absence of GH effects on cognitive function in girls with Turner’s syndrome. In our opinion, the statement that these results are in agreement with most of the previous studies that found no apparent GH treatment effects on cognitive function in patients with GH deficiency (GHD) needs a fair degree of caution.

In fact, although GH treatment is recommended worldwide for ameliorating the final height of girls with Turner’s syndrome, these patients are generally not classically GH-deficient. For this reason, we believe that the absence of GH effects on cognitive function, as clearly demonstrated by Ross et al. (1) in girls with Turner’s syndrome (without estrogen replacement treatment), is not easily comparable with the data obtained in GHD patients, in whom GH represents the "substitution" therapy.

Furthermore, the concern by Ross et al. (1) that the presence of multiple pituitary hormonal defects in adults with GHD could have a negative impact on brain development and could potentially interfere with the results of the psychological tests is not completely justified, as the majority of clinical studies [including the only mentioned (2)] have been performed in patients receiving stable and adequate hormonal replacement therapies.

As far as the effects of GH therapy on cognitive functions in adults with GHD are concerned, Degerblad et al. (3) actually found no significant effects of GH treatment; however, they suggested that the negative results could be tentatively explained by the difficulty in optimizing the measurement of subtle changes of mood and cognitive functions, rather than by a real lack of effects exerted by GH. In a short-term study (1 month) using GH treatment, Almqvist et al. (4) demonstrated that recombinant GH was able to improve cognitive psychometric testing, in particular the face recognition test, a test primarily for evaluating memory function.

Our experience in adults with childhood-onset GHD (5, 6) showed that 6 months of GH treatment caused an overall improvement in relation to intellectual tasks, accompanied by a lower level of stress during their performance. In particular, the scores of the tasks in the nonverbal Wechsler Adult Intelligence Scale (WAIS) and in the mental arithmetic test increased significantly, while those of "sensitivity," "thought," "impulsiveness," and "anxiety" scales (evaluated using the "Experiential-World Inventory"-EWI) reduced. The finding that the psychological characteristics of patients reverted to those before treatment after stopping recombinant GH supports the GH dependence of the effects observed during treatment.

In conclusion, as also stated by Ross et al. in their interesting paper (1), we agree that cognition in girls with Turner’s syndrome is more probably estrogen-dependent rather than GH-dependent, as the former actually represents the main feature of the syndrome. Further additional studies, aimed at correcting the real hormonal defects, are required to understand the potential reversibility (or not) of the neurocognitive deficits observed in Turner’s syndrome.

Footnotes

Address correspondence to: Alessandro Sartorio, M.D., Endocrine Unit, Italian Institute for Auxology, Via Ariosto 13, 20145 Milan, Italy.

Received October 21, 1997.

References

1. Ross JL, Feuillan P, Kushner H, Roeltgen D, Cutler Jr GB. 1997 Absence of growth hormone effects on cognitive function in girls with Turner syndrome. J Clin Endocrinol Metab. 82:1814–1817.[Abstract/Free Full Text]
2. Deijen JB, de Boer H, Blok GJ, van der Veen EA. 1996 Cognitive impairments and mood disturbances in growth hormone deficient men. Psychoneuroendocrinology. 21:313–322.[CrossRef][Medline]
3. Degerblad M, Almqvist O, Grunditz R, et al. 1990 Physical and psychological capabilities during substitution therapy with recombinant growth hormone in adults with growth hormone deficiency. Acta Endocrinol. 123:185–193.
4. Almkqvist O, Thoren M, Saaf M, Eriksson O. 1986 Effects of growth hormone substitution on mental performance in adults with growth hormone deficiency: a pilot study. Psychoneuroendocrinology. 11:347–352.[CrossRef][Medline]
5. Sartorio A, Molinari E, Riva G, Conti A, Morabito F, Faglia G. 1995 Growth hormone treatment in adults with childhood onset growth hormone deficiency: effects on psychological capabilities. Horm Res. 44:6–11.[Medline]
6. Sartorio A, Conti A, Molinari E, Riva G, Morabito F, Faglia G. 1996 Growth, growth hormone, and cognitive functions. Horm Res. 45:23–29.[Medline]

This Article Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sartorio, A. Articles by Molinari, E. Search for Related Content PubMed Articles by Sartorio, A. Articles by Molinari, E.