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Santos LOTD, Santos ADS, Oliveira MDS, Lopes NVDA, de Oliveira Júnior JK, Medeiros HCDM, Cunha JLS, Barnabé LÉG. Primary immune thrombocytopenic purpura with exuberant oral manifestations in a patient with Turner syndrome. SPECIAL CARE IN DENTISTRY 2024. [PMID: 38992892 DOI: 10.1111/scd.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/23/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Primary Immune Thrombocytopenic Purpura (ITP) is an autoimmune hematological condition characterized by isolated thrombocytopenia and frequently presents with oral manifestations. However, reports of primary ITP in patients with Turner Syndrome (TS) are exceptionally rare, with few cases documented in the literature. Herein, we describe an unusual case of primary ITP with exuberant oral manifestations in a patient with TS. CASE REPORT A 29-year-old woman was referred to an oral diagnostic service with complaints of "blood blisters and gum bleeding" lasting 8 h. On extraoral physical examination, multiple petechiae were observed in the upper and lower limbs, in addition to hemorrhagic extravasation in the right ocular sclera (hyposphagma). On intraoral examination, multiple vesicles and blisters filled with blood were identified on the lower lip, back of the tongue, and buccal mucosa, along with spontaneous gingival bleeding and hemorrhagic petechiae on the palate. Laboratory tests revealed thrombocytopenia (5000/mm3), whereas the blood count showed normality in the red and white series. After excluding other etiological factors or associated diseases, the patient was diagnosed with severe ITP and began treatment with systemic corticosteroids in the intensive care unit, resulting in a successful increase in platelets. After a 2-year follow-up, the patient remains free of ITP recurrences. CONCLUSION Oral manifestations may be one of the first signs of ITP. Therefore, it is essential that dentists are familiar with the condition and, when faced with unusual oral bleeding, consider the possibility of a hematological disorder such as ITP, ensuring a correct and early diagnosis. Moreover, the presence of ITP can further exacerbate complications associated with TS. Therefore, rigorous follow-up of these patients is crucial, considering the high incidence of cardiovascular and autoimmune diseases and the reduced life expectancy of these patients.
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Affiliation(s)
| | | | - Marielly de Souza Oliveira
- Center for Biological and Health Sciences, Federal University of Western Bahia (UFOB), Barreiras, Bahia, Brazil
| | | | | | | | - John Lennon Silva Cunha
- Center for Biological and Health Sciences, Federal University of Western Bahia (UFOB), Barreiras, Bahia, Brazil
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Bierley K, Antonarakis GS. Vertical cephalometric characteristics in different populations with Turner syndrome as compared to non-syndromic populations: A meta-analysis. SPECIAL CARE IN DENTISTRY 2024; 44:961-978. [PMID: 38391096 DOI: 10.1111/scd.12966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/27/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024]
Abstract
AIMS The present aim was to evaluate vertical cephalometric characteristics in populations with Turner syndrome (TS) using meta-analysis methodology. METHODS Six electronic databases were queried, up to August 2023, to identify studies comparing the vertical cephalometric characteristics in populations with TS, compared to female control groups. Data were extracted from eligible studies and random-effects meta-analysis was employed. Subgroup meta-analyses for age and karyotype were also attempted. Risk of bias was assessed using a modified version of the AXIS tool. RESULTS From the initial 195 studies identified, 17 were included in the quantitative synthesis, resulting in a sample of 417 patients with TS, originating from 10 different countries. Risk of bias was overall questionable. Mandibular ramus height was found to be smaller in females with TS, along with a reduction in posterior facial height, a larger anterior-posterior facial height ratio, and an increase in the mandibular plane angle. Subgroup meta-analyses showed that females with the monosomy X karyotype had vertical cephalometric characteristics which deviated more from the norm than those with other karyotypes. CONCLUSION The vertical lateral cephalometric characteristics of females with TS differ significantly from those of non-syndromic females, with the largest and most consistent deviation being seen in the monosomy X karyotype. Females with TS show less craniofacial posterior vertical development, with an evident reduction in mandibular ramus height leading to the cephalometric characteristics observed.
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Affiliation(s)
- Kara Bierley
- Division of orthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Gregory S Antonarakis
- Division of orthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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Paltoglou G, Ziakas N, Chrousos GP, Yapijakis C. Cephalometric Evaluation of Children with Short Stature of Genetic Etiology: A Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:792. [PMID: 39062241 PMCID: PMC11275085 DOI: 10.3390/children11070792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/17/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024]
Abstract
Introduction: A plethora of biological molecules regulate chondrogenesis in the epiphyseal growth plate. Disruptions of the quantity and function of these molecules can manifest clinically as stature abnormalities of various etiologies. Traditionally, the growth hormone/insulin-like growth factor 1 (IGF1) axis represents the etiological centre of final stature attainment. Of note, little is known about the molecular events that dominate the growth of the craniofacial complex and its correlation with somatic stature. Aim: Given the paucity of relevant data, this review discusses available information regarding potential applications of lateral cephalometric radiography as a potential clinical indicator of genetic short stature in children. Materials and Methods: A literature search was conducted in the PubMed electronic database using the keywords: cephalometric analysis and short stature; cephalometric analysis and achondroplasia; cephalometric analysis and hypochondroplasia; cephalometric analysis and skeletal abnormalities; cephalometr* and SHOX; cephalometr* and CNP; cephalometr* and ACAN; cephalometr* and CNVs; cephalometr* and IHH; cephalometr* and FGFR3; cephalometr* and Noonan syndrome; cephalometr* and "Turner syndrome"; cephalometr* and achondroplasia. Results: In individuals with genetic syndromes causing short stature, linear growth of the craniofacial complex is confined, following the pattern of somatic short stature regardless of its aetiology. The angular and linear cephalometric measurements differ from the measurements of the average normal individuals and are suggestive of a posterior placement of the jaws and a vertical growth pattern of the face. Conclusions: The greater part of the existing literature regarding cephalometric measurements in short-statured children with genetic syndromes provides qualitative data. Furthermore, cephalometric data for individuals affected with specific rare genetic conditions causing short stature should be the focus of future studies. These quantitative data are required to potentially establish cut-off values for reference for genetic testing based on craniofacial phenotypes.
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Affiliation(s)
- George Paltoglou
- Unit of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece;
| | - Nickolas Ziakas
- Unit of Orofacial Genetics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece;
| | - George P. Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, School of Medicine, National Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Christos Yapijakis
- Unit of Orofacial Genetics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece;
- University Research Institute of Maternal and Child Health and Precision Medicine, School of Medicine, National Kapodistrian University of Athens, 11527 Athens, Greece;
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Tallón-Walton V, Sánchez-Molins M, Hu W, Martínez-Abadías N, Casado A, Manzanares-Céspedes MC. Comprehensive Oral Diagnosis and Management for Women with Turner Syndrome. Diagnostics (Basel) 2024; 14:769. [PMID: 38611682 PMCID: PMC11011770 DOI: 10.3390/diagnostics14070769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
Turner Syndrome (TS) is a rare genetic disorder that affects females when one of the X chromosomes is partially or completely missing. Due to high genetic and phenotypic variability, TS diagnosis is challenging and is often delayed until adolescence, resulting in poor clinical management. Numerous oral, dental and craniofacial anomalies have been associated with TS, yet a comprehensive description is still lacking. This study addresses this gap through a detailed analysis of oral health and craniofacial characteristics in a cohort of 15 females with TS and their first-degree relatives. Subjects with TS ranged from 3 to 48 years old, none showed evidence of periodontal disease and only the youngest was in mixed dentition. Using the Multifunction System, we identified an aggregation of multiple signs and symptoms in each TS subject, including tooth anomalies (supernumerary molars, agenesis, microdontia, enamel defects, alterations in eruption patterns -advanced and delayed for chronological age-, crowding, rotations and transpositions), malocclusion (class II/1 and II/2) and Class II facial profile, while relatives exhibited fewer manifestations. The early detection of these signs and symptoms is crucial for appropriate referral and the optimal clinical management of TS, especially during the critical period of 9 to 10 years when congenital dental anomalies appear. The use of an established taxonomy to describe these phenotypic features is essential for early detection. Multidisciplinary teams are required to ensure holistic care management in rare diseases like TS.
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Affiliation(s)
- Victoria Tallón-Walton
- Human Anatomy and Embryology Unit, Experimental Pathology and Therapeutics Department, University of Barcelona, 08907 Barcelona, Spain; (V.T.-W.); (W.H.)
| | | | - Wenwen Hu
- Human Anatomy and Embryology Unit, Experimental Pathology and Therapeutics Department, University of Barcelona, 08907 Barcelona, Spain; (V.T.-W.); (W.H.)
| | - Neus Martínez-Abadías
- Evolutionary Biology, Ecology and Environmental Sciences Department, University of Barcelona, 08007 Barcelona, Spain;
| | - Aroa Casado
- Evolutionary Biology, Ecology and Environmental Sciences Department, University of Barcelona, 08007 Barcelona, Spain;
| | - María Cristina Manzanares-Céspedes
- Human Anatomy and Embryology Unit, Experimental Pathology and Therapeutics Department, University of Barcelona, 08907 Barcelona, Spain; (V.T.-W.); (W.H.)
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Lin H, Wang X, Qin S, Luo F, Cen Y, Lash GE, Li L. Incidence and risk factors of hearing loss in patients with Turner Syndrome. Front Public Health 2023; 11:1076812. [PMID: 36998272 PMCID: PMC10043252 DOI: 10.3389/fpubh.2023.1076812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 02/27/2023] [Indexed: 03/15/2023] Open
Abstract
BackgroundHearing loss (HL) is one of the main medical complications for Turner Syndrome (TS) patients, with an earlier presentation and higher incidence than normal women. However, the etiology of HL in TS is unclear. The aim of this study was to investigate the hearing status of TS patients in China and the influencing factors, so as to provide a theoretical basis for early intervention treatment for TS patients with HL.MethodsIn total 46 female patients aged 14–32 diagnosed with TS received tympanic membrane and audiological examinations, including pure tone audiometry and tympanometry. In addition, the effects of karyotype, sex hormone levels, thyroid function, insulin, blood lipids, bone mineral density, age and other factors on hearing levels were analyzed, and the possible risk factors associated with HL in TS patients were explored.ResultsIn 9 patients (19.6%) had HL, including 1 (2.2%) with mild conductive hearing loss, 5 (10.9%) with mild sensorineural hearing loss, 3 (6.5%) with moderate sensorineural hearing loss. TS is often associated with age-related mid-frequency and high-frequency HL, and the incidence of HL increases with age. Compared with other karyotypes, patients with 45, X haplotype have an increased risk of mid-frequency HL.ConclusionsTherefore, karyotype may be a predictor of hearing problems in TS.
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Affiliation(s)
- Huijia Lin
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaoya Wang
- Department of Ear, Nose, and Throat, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Shuang Qin
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Fanglan Luo
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yingmei Cen
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Gendie E. Lash
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Li Li
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- *Correspondence: Li Li
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Construction of Copy Number Variation Map Identifies Small Regions of Overlap and Candidate Genes for Atypical Female Genitalia Development. REPRODUCTIVE MEDICINE 2022. [DOI: 10.3390/reprodmed3020014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Copy number variations (CNVs) have been implicated in various conditions of differences of sexual development (DSD). Generally, larger genomic aberrations are more often considered disease-causing or clinically relevant, but over time, smaller CNVs have been associated with various forms of DSD. The main objective of this study is to identify small CNVs and the smallest regions of overlap (SROs) in patients with atypical female genitalia (AFG) and build a CNV map of AFG. We queried the DECIPHER database for recurrent duplications and/or deletions detected across the genome of AFG individuals. From these data, we constructed a chromosome map consisting of SROs and investigated such regions for genes that may be associated with the development of atypical female genitalia. Our study identified 180 unique SROs (7.95 kb to 45.34 Mb) distributed among 22 chromosomes. The most SROs were found in chromosomes X, 17, 11, and 22. None were found in chromosome 3. From these SROs, we identified 22 genes as potential candidates. Although none of these genes are currently associated with AFG, a literature review indicated that almost half were potentially involved in the development and/or function of the reproductive system, and only one gene was associated with a disorder that reported an individual patient with ambiguous genitalia. Our data regarding novel SROs requires further functional investigation to determine the role of the identified candidate genes in the development of atypical female genitalia, and this paper should serve as a catalyst for downstream molecular studies that may eventually affect the genetic counseling, diagnosis, and management of these DSD patients.
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Developmental Abnormalities of the Skull Base in Patients with Turner Syndrome. CURRENT HEALTH SCIENCES JOURNAL 2021; 46:329-335. [PMID: 33717506 PMCID: PMC7948014 DOI: 10.12865/chsj.46.04.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/18/2020] [Indexed: 12/02/2022]
Abstract
The skull base is one of the most complex anatomic structures of the skeleton that is responsible for protecting and supporting the brain and is also involved in the development of the facial structures. The main objective of our study was to evaluate skull base abnormalities in a group of patients diagnosed with Turner syndrome by assessing lateral cephalometric radiographs. A total of 7 patients diagnosed with Turner syndrome in the Endocrinology Department of the Emergency Clinical County Hospital of Craiova were included in the study. The following cephalometric variables were measured in our study: total skull base (N-Ba): Nasion (N)-Basion (Ba); anterior skull base (N-S): Nasion (N)-Sella (S); posterior skull base (S-Ba): Sella (S)-Basion (Ba). Regarding the investigated cephalometric variables, the mean±standard deviation (SD) recorded values in our study were 86.34±4.26mm for the total skull base (N-Ba), 63.87±2.54mm for the anterior skull base (N-S) and 38.33±4.87mm for the posterior skull base (S-Ba). The results of our study were compared to the ones provided by one of the most representative studies described in the literature. A reduced size of the posterior base of the skull is considered pathognomonic in subjects diagnosed with Turner syndrome. Also, the posterior base of the skull directly influences the maxillomandibular skeletal relationships and it is therefore necessary to calculate this cephalometric variable, which is easily highlighted on a lateral cephalometric radiograph.
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Wójcik D, Beń-Skowronek I. Craniofacial Morphology in Children with Growth Hormone Deficiency and Turner Syndrome. Diagnostics (Basel) 2020; 10:E88. [PMID: 32046211 PMCID: PMC7168196 DOI: 10.3390/diagnostics10020088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 12/31/2022] Open
Abstract
The review aims to collect and demonstrate recent knowledge about craniofacial morphology in growth hormone (GH)-deficient children and children with Turner syndrome. The review describes also the effects of growth hormone treatment on craniofacial morphology of children with growth hormone deficiency and Turner syndrome. Regardless of the disorder it accompanies, short stature is associated with similar craniofacial features characteristic of all short-statured children. Characteristic craniofacial features involve lesser dimensions of the cranial base and mandibular length, proportionately smaller posterior than anterior facial height, retrognathic face, and posterior rotation of the mandible. We also analyze orthodontic treatment in children affected by disorders associated with GH deficiency or provided with growth hormone treatment in the aspect of craniofacial growth. Recent publications show also the connection between growth hormone receptor polymorphism and craniofacial growth. Specialists and orthodontists treating short-statured children must be aware of the results of studies on craniofacial morphology and educate themselves on the topic of craniofacial growth in children with short stature. Moreover, knowledge of the influence of GH therapy on growth of craniofacial structures is necessary to decide the proper timing and planning of orthodontic treatment.
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Affiliation(s)
- Dorota Wójcik
- Department of Dental Prosthetics, Medical University of Lublin, 20-081 Lublin, Poland
| | - Iwona Beń-Skowronek
- Department of Paediatric Endocrinology and Diabetology with Endocrine—Metabolic Laboratory, Medical University of Lublin, 20-093 Lublin, Poland;
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Andrade NS, Tenório JR, Gallottini M. Supernumerary teeth in a patient with Turner syndrome: An unusual finding. SPECIAL CARE IN DENTISTRY 2019; 39:538-542. [DOI: 10.1111/scd.12412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/24/2019] [Accepted: 07/17/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Natália Silva Andrade
- Special Care CenterSchool of Dentistry, University of São Paulo, São Paulo São Paulo Brazil
| | - Jefferson R. Tenório
- Special Care CenterSchool of Dentistry, University of São Paulo, São Paulo São Paulo Brazil
| | - Marina Gallottini
- School of DentistrySpecial Care Center, University of São Paulo, São Paulo São Paulo Brazil
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Maier C, Dumančić J, Brkić H, Kaić Z, Savić Pavičin I, Poje Z, Scott GR. Tooth Crown Morphology in Turner and Klinefelter Syndrome Individuals from a Croatian Sample. Acta Stomatol Croat 2019; 53:106-118. [PMID: 31341318 PMCID: PMC6604557 DOI: 10.15644/asc53/2/2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/01/2019] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE Turner syndrome (TS) and Klinefelter syndrome (KS) represent the two most common X chromosome aneuploidies, each associated with systemic disruptions to growth and development. Effects of these conditions on tooth crown morphology are explored in a sample of Croatian individuals. MATERIALS AND METHODS The sample included 57 TS, 37 KS and 88 control individuals. Dental crown morphology was scored on dental casts according to the Turner-Scott Dental Anthropology System. RESULTS Incisor shoveling and the hypocone were significantly different between TS individuals and both control and KS individuals. Individuals with TS exhibit lower grades of expression than either group. Furthermore, the number of lingual cusps on the mandibular premolars, the hypoconulid on the mandibular second molar, and cusp 7 on the mandibular first molar were significantly different, though pair-wise comparisons did not elucidate these differences. Tuberculum dentale, distal accessory ridge, and Carabelli's trait were expressed similarly to the control. KS individuals were not significantly different from control individuals for any trait, though this may be related to sample size. CONCLUSIONS Previous studies suggest the loss of an X chromosome has a reducing effect on dental crown morphology, which is confirmed in this research. TS individuals exhibit generally simpler dental morphology compared to the control sample, though some traits are expressed comparably to the control sample. The effects of KS are less clear. Though previous studies suggest that the presence of an extra X chromosome increases dental crown dimensions, there was no notable effect on crown morphology in this study.
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Affiliation(s)
- Christopher Maier
- Eckerd College, Department of Anthropology, 4200 54 Ave. S. St. Petersburg, FL 33711, USA
| | - Jelena Dumančić
- University of Zagreb School of Dental Medicine, Department of Dental Anthropology, Zagreb, Croatia
- Department of Dental Medicine, University Hospital Centre Zagreb, Croatia
| | - Hrvoje Brkić
- University of Zagreb School of Dental Medicine, Department of Dental Anthropology, Zagreb, Croatia
- Department of Dental Medicine, University Hospital Centre Zagreb, Croatia
| | - Zvonimir Kaić
- Croatian Dental Chamber, Zagreb, Croatia
- Croatian Academy of Medical Sciences, Zagreb, Croatia
| | - Ivana Savić Pavičin
- University of Zagreb School of Dental Medicine, Department of Dental Anthropology, Zagreb, Croatia
| | - Zvonko Poje
- Croatian Dental Chamber, Zagreb, Croatia
- Croatian Academy of Medical Sciences, Zagreb, Croatia
| | - G. Richard Scott
- University of Nevada, Reno, Department of Anthropology, 1664 N. Virginia St., Reno, NVUSA
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Cazzolla AP, Lo Muzio L, Di Fede O, Lacarbonara V, Colaprico A, Testa NF, Giuseppe T, Zhurakivska K, Marzo G, Lacaita MG. Orthopedic-orthodontic treatment of the patient with Turner's syndrome: Review of the literature and case report. SPECIAL CARE IN DENTISTRY 2018; 38:239-248. [DOI: 10.1111/scd.12295] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine; University of Foggia; Foggia Italy
| | - Olga Di Fede
- Department of Surgical; Oncological and Stomatological Sciences; University of Palermo; Palermo Italy
| | | | - Andrea Colaprico
- Department of Odontostomatology and Surgery; University of Bari; Bari Italy
| | - Nunzio F. Testa
- Department of Clinical and Experimental Medicine; University of Foggia; Foggia Italy
| | - Troiano Giuseppe
- Department of Clinical and Experimental Medicine; University of Foggia; Foggia Italy
| | - Khrystyna Zhurakivska
- Department of Clinical and Experimental Medicine; University of Foggia; Foggia Italy
| | - Giuseppe Marzo
- Department of Life; Health and Environmental Sciences; Dental Clinic; University of L'Aquila; L'Aquila Italy
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Gravholt CH, Andersen NH, Conway GS, Dekkers OM, Geffner ME, Klein KO, Lin AE, Mauras N, Quigley CA, Rubin K, Sandberg DE, Sas TCJ, Silberbach M, Söderström-Anttila V, Stochholm K, van Alfen-van derVelden JA, Woelfle J, Backeljauw PF. Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting. Eur J Endocrinol 2017; 177:G1-G70. [PMID: 28705803 DOI: 10.1530/eje-17-0430] [Citation(s) in RCA: 602] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/07/2017] [Indexed: 12/14/2022]
Abstract
Turner syndrome affects 25-50 per 100,000 females and can involve multiple organs through all stages of life, necessitating multidisciplinary approach to care. Previous guidelines have highlighted this, but numerous important advances have been noted recently. These advances cover all specialty fields involved in the care of girls and women with TS. This paper is based on an international effort that started with exploratory meetings in 2014 in both Europe and the USA, and culminated with a Consensus Meeting held in Cincinnati, Ohio, USA in July 2016. Prior to this meeting, five groups each addressed important areas in TS care: 1) diagnostic and genetic issues, 2) growth and development during childhood and adolescence, 3) congenital and acquired cardiovascular disease, 4) transition and adult care, and 5) other comorbidities and neurocognitive issues. These groups produced proposals for the present guidelines. Additionally, four pertinent questions were submitted for formal GRADE (Grading of Recommendations, Assessment, Development and Evaluation) evaluation with a separate systematic review of the literature. These four questions related to the efficacy and most optimal treatment of short stature, infertility, hypertension, and hormonal replacement therapy. The guidelines project was initiated by the European Society for Endocrinology and the Pediatric Endocrine Society, in collaboration with The European Society for Pediatric Endocrinology, The Endocrine Society, European Society of Human Reproduction and Embryology, The American Heart Association, The Society for Endocrinology, and the European Society of Cardiology. The guideline has been formally endorsed by the European Society for Endocrinology, the Pediatric Endocrine Society, the European Society for Pediatric Endocrinology, the European Society of Human Reproduction and Embryology and the Endocrine Society. Advocacy groups appointed representatives who participated in pre-meeting discussions and in the consensus meeting.
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Affiliation(s)
- Claus H Gravholt
- Departments of Endocrinology and Internal Medicine
- Departments of Molecular Medicine
| | - Niels H Andersen
- Departments of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Gerard S Conway
- Department of Women's Health, University College London, London, UK
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mitchell E Geffner
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Karen O Klein
- Rady Children's Hospital, University of California, San Diego, California, USA
| | - Angela E Lin
- Department of Pediatrics, Medical Genetics Unit, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Nelly Mauras
- Division of Endocrinology, Nemours Children's Health System, Jacksonville, Florida, USA
| | | | - Karen Rubin
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - David E Sandberg
- Division of Psychology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Theo C J Sas
- Department of Pediatric Endocrinology, Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Pediatrics, Dordrecht, The Netherlands
| | - Michael Silberbach
- Department of Pediatrics, Doernbecher Children's Hospital, Portland, Oregon, USA
| | | | - Kirstine Stochholm
- Departments of Endocrinology and Internal Medicine
- Center for Rare Diseases, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Joachim Woelfle
- Department of Pediatric Endocrinology, Children's Hospital, University of Bonn, Bonn, Germany
| | - Philippe F Backeljauw
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Juloski J, Dumančić J, Šćepan I, Lauc T, Milašin J, Kaić Z, Dumić M, Babić M. Growth hormone positive effects on craniofacial complex in Turner syndrome. Arch Oral Biol 2016; 71:10-15. [PMID: 27372203 DOI: 10.1016/j.archoralbio.2016.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 04/10/2016] [Accepted: 06/09/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Turner syndrome occurs in phenotypic females with complete or partial absence of X chromosome. The leading symptom is short stature, while numerous but mild stigmata manifest in the craniofacial region. These patients are commonly treated with growth hormone to improve their final height. The aim of this study was to assess the influence of long-term growth hormone therapy on craniofacial morphology in Turner syndrome patients. DESIGN In this cross-sectional study cephalometric analysis was performed on 13 lateral cephalograms of patients with 45,X karyotype and the average age of 17.3 years, who have received growth hormone for at least two years. The control group consisted of 13 Turner syndrome patients naive to growth hormone treatment, matched to study group by age and karyotype. Sixteen linear and angular measurements were obtained from standard lateral cephalograms. Standard deviation scores were calculated in order to evaluate influence of growth hormone therapy on craniofacial components. RESULTS In Turner syndrome patients treated with growth hormone most of linear measurements were significantly larger compared to untreated patients. Growth hormone therapy mainly influenced posterior face height, mandibular ramus height, total mandibular length, anterior face height and maxillary length. While the increase in linear measurements was evident, angular measurements and facial height ratio did not show statistically significant difference. Acromegalic features were not found. CONCLUSIONS Long-term growth hormone therapy has positive influence on craniofacial development in Turner syndrome patients, with the greatest impact on posterior facial height and mandibular ramus. However, it could not compensate X chromosome deficiency and normalize craniofacial features.
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Affiliation(s)
- Jovana Juloski
- Department of Orthodontics, School of Dental Medicine, University of Belgrade, Gastona Gravijea 2, 11000 Belgrade, Serbia.
| | - Jelena Dumančić
- Department of Dental Anthropology, School of Dental Medicine, University of Zagreb, Gundulićeva 5, 10000 Zagreb, Croatia; Department of Dental Medicine, University Hospital Center Zagreb, Gundulićeva 5, 10000 Zagreb, Croatia.
| | - Ivana Šćepan
- Department of Orthodontics, School of Dental Medicine, University of Belgrade, Gastona Gravijea 2, 11000 Belgrade, Serbia.
| | - Tomislav Lauc
- Department of Anthropology, Faculty of Social Sciences and Humanities, University of Zagreb, Ivana Lučića 3, 10000 Zagreb, Croatia,; Department of Otorhinolaryngology and Maxillofacial Surgery, Faculty of Medicine, University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia.
| | - Jelena Milašin
- Institute of Biology and Human Genetics, School of Dental Medicine, University of Belgrade, Dr. Subotića 1, 11000 Belgrade, Serbia.
| | - Zvonimir Kaić
- Croatian Dental Chamber, Kurelčeva 3, 10000 Zagreb, Croatia; Croatian Academy of Medical Sciences, Praška 2, 10000 Zagreb, Croatia.
| | - Miroslav Dumić
- Medical Faculty, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia.
| | - Marko Babić
- Institute of Biology and Human Genetics, School of Dental Medicine, University of Belgrade, Dr. Subotića 1, 11000 Belgrade, Serbia.
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Oliveira CS, Ribeiro FM, Lago R, Alves C. Audiological abnormalities in patients with Turner syndrome. Am J Audiol 2015; 22:226-32. [PMID: 23824435 DOI: 10.1044/1059-0889(2013/11-0027)] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the prevalence, type, and severity of hearing impairment in patients with Turner syndrome (TS) and to determine whether these characteristics correlated with the patient karyotype and age. METHOD This was a cross-sectional prospective study. The participants underwent an audiological evaluation, including pure-tone audiometry, speech audiometry, and acoustic immittance measures. RESULTS This study included 52 patients with TS (mean age = 19 years, SD = 6 years, range = 7-37 years). The majority of these patients had a decline in pure-tone thresholds at 8000 Hz, and most also had mild to moderate hearing loss. Most patients had normal tympanometric results. More than 80% of patients had acoustic reflexes present at 500, 1000, and 2000 Hz frequencies bilaterally, but less than 50% of the patients displayed an acoustic reflex at 4000 Hz bilaterally. The hearing loss was more prevalent in patients with a 45,X karyotype and isochromosomes as compared to patients with mosaicism. CONCLUSION The results showed that TS patients with a 45,X karyotype and isochromosomes with loss of the p-arm of the X chromosome had a greater risk of developing hearing loss than patients with mosaicism. There was a linear association between hearing loss and age in these patients.
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Affiliation(s)
| | | | - Renata Lago
- Genetics Services Unit, Hospital Universitário Prof. Edgard Santos, Federal University of Bahia, Salvador-Bahia, Brazil
| | - Crésio Alves
- Pediatric Endocrinology Unit, Hospital Universitário Prof. Edgard Santos, Faculty of Medicine, Federal University of Bahia, Salvador-Bahia, Brazil
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15
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Ontogenetic changes of craniofacial complex in Turner syndrome patients treated with growth hormone. Clin Oral Investig 2012; 17:1563-71. [PMID: 23001189 DOI: 10.1007/s00784-012-0844-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 09/09/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The present study assessed changes of craniofacial complex in Turner syndrome (TS) patients treated with growth hormone (GH) during development. The objective was to examine the growth rate and pattern of craniofacial structures and to establish effects of GH on craniofacial development. MATERIALS AND METHODS The study population consisted of 15 TS patients treated with GH aged 5-18.5 years (13.3 ± 4.4) and corresponding control group of 45 females aged 6.8-18.7 (11.4 ± 2.6). According to the stage of cervical vertebral maturation, subjects were categorized into pre-growth (5 TS and 15 controls) and growth (10 TS and 30 controls) subgroups. The cephalometric analysis comprised angular and linear variables, measured on lateral cephalometric radiographs. RESULTS The mandibular corpus/anterior cranial base ratio increased significantly only in controls during development. In growth period, ramus/corpus ratio was significantly larger in TS group. SNA and SNB angles were significantly smaller in TS growth subgroup compared to corresponding controls. Among other variables, no statistically significant differences were revealed. CONCLUSIONS In TS patients treated with GH, growth capacities of cranial base and maxilla are adequate which can be attributed to GH treatment. Shape of mandible is altered due to decreased growth of corpus and overdeveloped ramus. Both maxillary and mandibular retrognathism are becoming more expressed during development. CLINICAL RELEVANCE Favorable influence of GH on craniofacial complex growth rate and altered growth pattern revealed in this study should be considered while planning both orthodontic treatment and retention.
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El-Bassyouni HT, Afifi HH, Aglan MS, Mahmoud WM, Zaki ME. Growth curves of Egyptian patients with Turner syndrome. Am J Med Genet A 2012; 158A:2687-91. [PMID: 22847945 DOI: 10.1002/ajmg.a.35518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 05/13/2012] [Indexed: 11/12/2022]
Abstract
This study analyzes the body anthropometric measurements in females with Turner syndrome (TS) not treated with recombinant human growth hormone. Height, weight, head circumference, and body mass index (BMI) data were collected from 93 patients. Their ages ranged from 6 months to 24 years (mean 10 ± 4.3 years). Chromosomal analysis revealed: 55 patients with 45,X and 38 patients with mosaic karyotypes. Patients were divided into yearly age groups. Standard growth curves were constructed for these Egyptian Turner syndrome (TS) patients. Mean and standard deviations were estimated across the age groups. When comparing the mean heights of patients to the Egyptian standards, short stature (≤2 SD) was found in 96.8% of patients older than 6 years. Patients' mean weight and BMI were higher than controls. The mean height of the studied Egyptian patients was slightly lower than that of females with TS in UK and European patients. Therefore, local reference values are more appropriate than International standards. The charts presented here can be used to optimize routine healthcare for Egyptian TS patients. The use of growth charts specific for Egyptian TS patients can help to discover early physical developmental delay and suggests the necessity of looking for concomitant diseases affecting growth.
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Nguyen CT, Hofstede TM. Prosthodontic treatment and medical considerations for a patient with Turner syndrome: a clinical report. J Prosthodont 2012; 21:552-5. [PMID: 22672559 DOI: 10.1111/j.1532-849x.2012.00868.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This clinical report describes a multidisciplinary approach in the rehabilitation of a 23-year-old Caucasian woman affected with Turner's syndrome and subsequently diagnosed with T4 Giant cell reparative granuloma of the right maxillary sinus. The surgical treatment included a maxillectomy and infratemporal fossa dissection followed by a free fibula palatal reconstruction, fibula bone graft of the orbital floor, dental implant placement, and prosthodontic rehabilitation. Prosthodontic planning and treatment considerations in an adult patient with Turner Syndrome are discussed.
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Affiliation(s)
- Caroline T Nguyen
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada.
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Rizell S, Barrenas ML, Andlin-Sobocki A, Stecksen-Blicks C, Kjellberg H. 45,X/46,XX karyotype mitigates the aberrant craniofacial morphology in Turner syndrome. Eur J Orthod 2012; 35:467-74. [DOI: 10.1093/ejo/cjs014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Eklund M, Kotilainen J, Evälahti M, Waltimo-Sirén J. Cephalometric analysis of pharyngeal airway space dimensions in Turner syndrome. Eur J Orthod 2012; 34:219-25. [PMID: 22275513 DOI: 10.1093/ejo/cjs001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Turner syndrome (TS) that is due to a total or partial lack of an X chromosome affects about 1 in 2000 girls. The syndrome is characterized by short stature and gonadal dysgenesis. Its documented craniofacial features include retrognathic jaws, a short mandible, and a large cranial base angle. Our aim was to find out whether the syndrome also has an effect on the pharyngeal airway space. We retrospectively analysed lateral cephalograms of 35 TS subjects whose age ranged from 6.5 to 21 years and of 35 healthy female controls matched for age. On those, we did 7 linear and 10 angular cephalometric measurements and 9 pharyngeal measurements. Differences between the subjects with TS and their controls were assessed by paired two-tailed T-test. In the girls with TS, both the maxilla and the mandible were more retrognathic (SNA, P = 0.015 and SNB, P < 0.001), the mandible was shorter (TM-Pgn, P = 0.016), and the cranial base angle was larger (SNBa, P = 0.025) than in the controls, confirming the results of earlier studies. Notably, all six pharyngeal airway measurements were smaller in girls with TS. Two of them, PNS-ad2 and PAS, were statistically significantly smaller (P = 0.019 and P = 0.012, respectively). Thus, a narrow pharynx, either as a primary finding or as a consequence of the maxillo-mandibular retrognathism, further delineates the phenotype. This may imply an elevated risk of sleep apnoea in females with TS.
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Affiliation(s)
- Mikaela Eklund
- Department of Orthodontics, Institute of Dentistry, University of Helsinki, Finland.
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Mandelli SA, Abramides DVM. Manifestações clínicas e fonoaudiológicas na Síndrome de Turner: estudo bibliográfico. REVISTA CEFAC 2011. [DOI: 10.1590/s1516-18462011005000081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
TEMA: síndrome genética e achados fonoaudiológicos. OBJETIVO: descrever as manifestações clínicas e fonoaudiológicas em indivíduos com a Síndrome de Turner CONCLUSÃO: foram levantados 23 artigos sobre a Síndrome de Turner dos quais 7 discorriam sobre a audição e suas alterações nesses indivíduos, 6 sobre linguagem receptiva e/ou expressiva e praxia, 5 sobre aspectos psicológicos e cognitivos além de 28 artigos referentes às manifestações clínicas em geral. Por meio do levantamento bibliográfico pode-se observar que as manifestações fonoaudiológicas na Síndrome de Turner são pouco estudadas e, dentro da fonoaudiologia as manifestações audiológicas como perda de audição e otites são as mais estudadas, ao contrário dos aspectos práxicos e de recepção/ expressão da linguagem.
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Rizell S, Barrenäs ML, Andlin-Sobocki A, Stecksén-Blicks C, Kjellberg H. Turner syndrome isochromosome karyotype correlates with decreased dental crown width. Eur J Orthod 2011; 34:213-8. [PMID: 21303812 DOI: 10.1093/ejo/cjq196] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- S Rizell
- Department of Orthodontics, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
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