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Mann L, VanLooy L. The impact of amplification on quality of life in women with Turner syndrome. Orphanet J Rare Dis 2024; 19:119. [PMID: 38481335 PMCID: PMC10938653 DOI: 10.1186/s13023-024-03122-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Individuals with Turner syndrome (TS, ORPHA 881) experience barriers in communication throughout life as they navigate both early conductive, and progressive sensorineural hearing loss amid other healthcare needs. Hearing loss is self-identified as one of the largest unmet healthcare needs. PURPOSE The purpose of this study was to investigate the impact of treatment for hearing loss on communication confidence and quality of life measures for individuals with TS. RESEARCH DESIGN We employed a prospective cross-sectional study design that included both online survey data and audiometric data for a subset of participants. STUDY SAMPLE We recruited 179 adults with TS at the Turner Syndrome Society of the United States (TSSUS) Conference, and through a variety of regional TS organizations' social media platforms. Audiological data was collected onsite at the conference for a subset of 67 participants; 8 of which who were followed after receiving subsequent treatment with hearing aids. DATA COLLECTION AND ANALYSIS The online survey design included demographic questions, the Communication Confidence Profile (CCP), and the RAND 36-Item Health Survey 1.0. Audiometric data included tympanometry, puretone air, and puretone bone conduction thresholds. Descriptive statistics, parametric, and non-parametric tests were used to analyze both survey and audiometric data. RESULTS 74% of participants had a self-reported diagnosis of hearing loss, of which 61% were previously recommended amplification. Only 38% of participants reported using hearing aids. For those participants who wore hearing aids, Total CCP Score, 'Confidence in Ability to Hear Under Various Conditions', and 'Energy/Vitality' metrics were significantly greater than those with untreated hearing loss warranting a hearing aid. Collectively, Total CCP Score and 'Confidence in Ability to Hear Under Various Conditions' increased significantly when participants were fit with hearing aids. CONCLUSION The results support previous data where hearing loss is a self-identified healthcare concern among women with Turner syndrome, yet many fail to receive appropriate hearing evaluation or treatment. Additionally, the use of hearing aids may improve communication confidence and quality of life in women with Turner syndrome. Furthermore, this study confirms the need for long-term audiological care and monitoring in women with Turner syndrome.
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Affiliation(s)
- Lauren Mann
- University of Kansas Medical Center, 3901 Rainbow Blvd MS 3047, 66160, Kansas City, KS, USA.
| | - Lindsey VanLooy
- University of North Carolina Hospitals, Chapel Hill, NC, USA
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2
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Velvin G, Dammann B, Haagensen T, Johansen H, Strømme H, Geirdal AØ, Bathen T. Work participation in adults with rare genetic diseases - a scoping review. BMC Public Health 2023; 23:910. [PMID: 37208707 DOI: 10.1186/s12889-023-15654-3] [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: 11/09/2022] [Accepted: 04/11/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Work participation is a crucial aspect of health outcome and an important part of life for most people with rare genetic diseases. Despite that work participation is a social determinant of health and seems necessary for understanding health behaviours and quality of life, it is an under-researched and under-recognized aspect in many rare diseases. The objectives of this study was to map and describe existing research on work participation, identify research gaps, and point to research agendas in a selection of rare genetic diseases. METHODS A scoping review was performed by searching relevant literature in bibliographic databases and other sources. Studies addressing work participation in people with rare genetic diseases published in peer reviewed journals were assessed using EndNote and Rayyan. Data were mapped and extracted based on the research questions concerning the characteristics of the research. RESULTS Of 19,867 search results, 571 articles were read in full text, and 141 satisfied the eligibility criteria covering 33 different rare genetic diseases; 7 were reviews and 134 primary research articles. In 21% of the articles the primary aim was to investigate work participation. The extent of studies varied between the different diseases. Two diseases had more than 20 articles, but most had only one or two articles. Cross-sectional quantitative studies were predominant, with few utilizing prospective or qualitative design. Nearly all articles (96%) reported information about work participation rate, and 45% also included information about factors associated with work participation and work disability. Due to differences in methodologies, cultures and respondents, comparison between and within diseases are difficult. Nevertheless, studies indicated that many people with different rare genetic diseases experience challenges related to work, closely associated to the symptoms of the disease. CONCLUSION While studies indicate high prevalence of work disability in many patients with rare diseases, the research is scarce and fragmented. More research is warranted. Information about the unique challenges of living with different rare diseases is crucial for health and welfare systems to better facilitate work participation. In addition, the changing nature of work in the digital age, may also open up new possibilities for people with rare genetic diseases and should be explored.
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Affiliation(s)
- Gry Velvin
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway.
| | - Brede Dammann
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
| | - Trond Haagensen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
| | - Heidi Johansen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
| | - Hilde Strømme
- Library of Medicine and Science, University of Oslo, Oslo, Norway
| | - Amy Østertun Geirdal
- Department of Social Work, Child Welfare and Social Policy, Faculty of Social Science, Oslo Metropolitan University, Oslo, Norway
| | - Trine Bathen
- TRS National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Oslo, 1450, Norway
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van den Hoven AT, Bons LR, Dykgraaf RHM, Dessens AB, Pastoor H, de Graaff LCG, Metselaar MR, Kneppers‐ Swets A, Kardys I, Mijnarends H, Zweerus F, Hazelzet JA, Utens EMWJ, van den Bosch AE, Roos‐Hesselink JW. A value-based healthcare approach: Health-related quality of life and psychosocial functioning in women with Turner syndrome. Clin Endocrinol (Oxf) 2020; 92:434-442. [PMID: 32003479 PMCID: PMC7216918 DOI: 10.1111/cen.14166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/26/2020] [Accepted: 01/28/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE As part of the value-based healthcare programme in our hospital, a set of patient-reported outcome measures was developed together with patients and implemented in the dedicated Turner Syndrome (TS) outpatient clinic. This study aims to investigate different aspects of health-related quality of life (HR-QoL) and psychosocial functioning in women with TS in order to establish new possible targets for therapy. DESIGN/PARTICIPANTS A comprehensive set of questionnaires (EQ-5D, PSS-10, CIS-20, Ferti-QoL, FSFI) was developed and used to capture different aspects of HR-QoL and psychosocial functioning in a large cohort of adult women with Turner syndrome. All consecutive women, ≥18 years, who visited the outpatient clinic of our tertiary centre were eligible for inclusion. RESULTS Of the eligible 201 women who were invited to participate, 177 women (age 34 ± 12 years, mean ± SD) completed at least one of the validated questionnaires (88%). Women with TS reported a lower health-related quality of life (EQ-5D: 0.857 vs 0.892, P = .003), perceived more stress (PSS-10:14.7 vs 13.3; P = .012) and experienced increased fatigue (CIS-20: P < .001) compared to the general Dutch population. A relationship between noncardiac comorbidities (eg diabetes, orthopaedic complaints) and HR-QoL was found (R = .508). CONCLUSIONS We showed that TS women suffer from impaired HR-QoL, more perceived stress and increased fatigue compared to healthy controls. A relationship between noncardiac comorbidities and HR-QoL was found. Especially perceived stress and increased fatigue can be considered targets for improvement of HR-QoL in TS women.
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Affiliation(s)
| | - Lidia R. Bons
- Department of CardiologyErasmus Medical CenterRotterdamThe Netherlands
| | | | - Arianne B. Dessens
- Department of Child and Adolescent Psychiatry/PsychologyErasmus Medical Center, University Medical Center RotterdamRotterdamThe Netherlands
| | - Hester Pastoor
- Department of GynecologyErasmus Medical CenterRotterdamThe Netherlands
| | | | - Mick R. Metselaar
- Department of OtolaryngologyErasmus Medical CenterRotterdamThe Netherlands
| | | | - Isabella Kardys
- Department of Clinical EpidemiologyErasmus Medical CenterRotterdamThe Netherlands
| | - Hester Mijnarends
- Department of CardiologyErasmus Medical CenterRotterdamThe Netherlands
| | - Frank Zweerus
- Department of Quality and Patient careErasmus Medical CenterRotterdamThe Netherlands
| | - Jan A. Hazelzet
- Department of Public HealthErasmus Medical CenterRotterdamThe Netherlands
| | - Elisabeth M. W. J. Utens
- Department of Child and Adolescent Psychiatry/PsychologyErasmus Medical Center, University Medical Center RotterdamRotterdamThe Netherlands
- Research Institute of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Child and Adolescent PsychiatryAcademic Center for Child Psychiatry the Bascule, Academic Medical CenterAmsterdamThe Netherlands
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Kahlert E, Blaschke M, Brockmann K, Freiberg C, Janssen OE, Stahnke N, Strik D, Merkel M, Mann A, Liesenkötter KP, Siggelkow H. Deficient knowledge in adult Turner syndrome care as an incentive to found Turner centers in Germany. Endocr Connect 2019; 8:1483-1492. [PMID: 31627185 PMCID: PMC6865863 DOI: 10.1530/ec-19-0418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/18/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Turner syndrome (TS) is characterized by the complete or partial loss of the second sex chromosome and associated with a wide range of clinical manifestations. We aimed to assess the medical care of adult patients with TS in Germany. DESIGN Retrospective multicenter observational study. METHODS Data were collected from medical records of 258 women with TS treated between 2001 and 2017 in five non-university endocrinologic centers in Germany. RESULTS Mean age was 29.8 ± 11.6 years, mean height 152 ± 7.7 cm, and mean BMI 26.6 ± 6.3 kg/m2. The karyotype was known in 50% of patients. Information on cholesterol state, liver enzymes, and thyroid status was available in 81-98% of women with TS; autoimmune thyroiditis was diagnosed in 37%. Echocardiography was performed in 42% and cardiac MRI in 8.5%, resulting in a diagnosis of cardiovascular disorder in 28%. Data on growth hormone therapy were available for 40 patients (15%) and data concerning menarche in 157 patients (61%). CONCLUSION In 258 women with TS, retrospective analysis of healthcare data indicated that medical management was focused on endocrine manifestations. Further significant clinical features including cardiovascular disease, renal malformation, liver involvement, autoimmune diseases, hearing loss, and osteoporosis were only marginally if at all considered. Based on this evaluation and in accordance with recent guidelines, we compiled a documentation form facilitating the transition from pediatric to adult care and further medical management of TS patients. The foundation of Turner Centers in March 2019 will improve the treatment of TS women in Germany.
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Affiliation(s)
- Elin Kahlert
- Clinic of Gastroenterology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany
| | - Martina Blaschke
- Clinic of Gastroenterology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany
- Endokrinologikum Goettingen, Goettingen, Germany
| | - Knut Brockmann
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders, University Medical Center Goettingen, Goettingen, Germany
| | - Clemens Freiberg
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders, University Medical Center Goettingen, Goettingen, Germany
| | | | | | | | | | | | | | - Heide Siggelkow
- Clinic of Gastroenterology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany
- Endokrinologikum Goettingen, Goettingen, Germany
- Correspondence should be addressed to H Siggelkow:
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Lin AE, Prakash SK, Andersen NH, Viuff MH, Levitsky LL, Rivera-Davila M, Crenshaw ML, Hansen L, Colvin MK, Hayes FJ, Lilly E, Snyder EA, Nader-Eftekhari S, Aldrich MB, Bhatt AB, Prager LM, Arenivas A, Skakkebaek A, Steeves MA, Kreher JB, Gravholt CH. Recognition and management of adults with Turner syndrome: From the transition of adolescence through the senior years. Am J Med Genet A 2019; 179:1987-2033. [PMID: 31418527 DOI: 10.1002/ajmg.a.61310] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/11/2019] [Accepted: 07/18/2019] [Indexed: 12/16/2022]
Abstract
Turner syndrome is recognized now as a syndrome familiar not only to pediatricians and pediatric specialists, medical geneticists, adult endocrinologists, and cardiologists, but also increasingly to primary care providers, internal medicine specialists, obstetricians, and reproductive medicine specialists. In addition, the care of women with Turner syndrome may involve social services, and various educational and neuropsychologic therapies. This article focuses on the recognition and management of Turner syndrome from adolescents in transition, through adulthood, and into another transition as older women. It can be viewed as an interpretation of recent international guidelines, complementary to those recommendations, and in some instances, an update. An attempt was made to provide an international perspective. Finally, the women and families who live with Turner syndrome and who inspired several sections, are themselves part of the broad readership that may benefit from this review.
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Affiliation(s)
- Angela E Lin
- Medical Genetics Unit, Mass General Hospital for Children, Boston, Massachusetts
| | - Siddharth K Prakash
- Division of Cardiology, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Mette H Viuff
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lynne L Levitsky
- Division of Pediatric Endocrinology, Department of Pediatrics, Mass General Hospital for Children, Boston, Massachusetts
| | - Michelle Rivera-Davila
- Division of Pediatric Endocrinology, Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Melissa L Crenshaw
- Medical Genetics Services, Division of Genetics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Lars Hansen
- Department of Otorhinolaryngology, Aarhus University Hospital, Aarhus, Denmark
| | - Mary K Colvin
- Psychology Assessment Center, Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Frances J Hayes
- Reproductive Endocrine Unit of the Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Evelyn Lilly
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Emma A Snyder
- Medical Genetics Unit, Mass General Hospital for Children, Boston, Massachusetts
| | - Shahla Nader-Eftekhari
- Division of Endocrinology, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Melissa B Aldrich
- Center for Molecular Imaging, The Brown Institute for Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Ami B Bhatt
- Corrigan Minehan Heart Center, Adult Congenital Heart Disease Program, Massachusetts General Hospital, Boston, Massachusetts.,Yawkey Center for Outpatient Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Laura M Prager
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Ana Arenivas
- Department of Rehabilitation Psychology/Neuropsychology, TIRR Memorial Hermann Rehabilitation Network, Houston, Texas.,Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Anne Skakkebaek
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Marcie A Steeves
- Medical Genetics Unit, Mass General Hospital for Children, Boston, Massachusetts
| | - Jeffrey B Kreher
- Department of Pediatrics and Orthopaedics, Massachusetts General Hospital, Boston, Massachusetts
| | - Claus H Gravholt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
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Puce L, Marinelli L, Girtler NG, Pallecchi I, Mori L, Simonini M, Trompetto C. Self-Perceived Psychophysical Well-Being of Young Competitive Swimmers With Physical or Intellectual Impairment. Percept Mot Skills 2019; 126:862-885. [PMID: 31362582 DOI: 10.1177/0031512519865849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Regular practice of sport activities yields psychophysical benefits for both the general population and persons affected by physical or intellectual impairments. Practicing competitive sport may add further value to these benefits. The objective of this observational cross-sectional study was to investigate the role of competitive sport practice in enhancing self-perceived psychophysical well-being of some select participants, using the Psychological General Well-Being Index and the Short Form-12 indices. We recruited at national events 100 young Italian competitive swimmers affected by physical or intellectual impairment. These respondents' results were compared with those of a control group of 100 Italian participants who did not practice competitive sport but who were also affected by physical or intellectual impairment, randomly selected from rehabilitation clinics and communities of young people with disabilities. Scores of psychological and emotional well-being were higher by 40% or more for the practitioners of competitive sport (p < .0001; Cohen's effect size d ≥ 1.3). While our study's results suggest possible positive psychophysical benefits to competitive sport practice for young people affected by physical or intellectual impairment, longitudinal research is needed to be certain that our results are not due to self-selection into sports participation of those persons with disabilities who have a uniquely higher sense of well-being.
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Affiliation(s)
- Luca Puce
- 1 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy
| | - Lucio Marinelli
- 1 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy
| | - Nicola G Girtler
- 1 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy
| | | | - Laura Mori
- 1 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy
| | - Marina Simonini
- 3 Struttura Complessa Recupero e Rieducazione Funzionale, ASL3 Regione Liguria, Italy
| | - Carlo Trompetto
- 1 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy
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7
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Bons LR, van den Hoven AT, Damirchi AE, van der Linde D, Dekker S, Kauling RM, van de Laar IMBH, Utens EMWJ, Budde RPJ, Roos-Hesselink JW. Psychological well-being in patients with aneurysms-osteoarthritis syndrome. Am J Med Genet A 2019; 179:1491-1497. [PMID: 31132219 PMCID: PMC6771664 DOI: 10.1002/ajmg.a.61209] [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: 01/18/2019] [Revised: 04/16/2019] [Accepted: 05/09/2019] [Indexed: 01/26/2023]
Abstract
Aneurysms-osteoarthritis syndrome (AOS) is characterized by arterial aneurysms and dissection in combination with early-onset osteoarthritis, which can impact quality of life. We describe the subjective quality of life and investigate anxiety and depression in 28 AOS patients aged 15-73 years. Three questionnaires were used: 36-Item Short Form Survey (SF-36), hospital anxiety and depression scale (HADS) and Rotterdam disease specific questionnaire. Results of the SF-36 and HADS were compared to a reference Dutch cohort and the SF-36 questionnaire also to patients with Marfan syndrome. Compared to the general population, AOS patients scored significantly lower on the following SF-36 domains: physical functioning, vitality, social functioning, bodily pain, and general health. Physical functioning was also lower than in Marfan patients. Patients with AOS scored higher on the HADS depression scale, while anxiety did not show a significant difference compared to the general population. No difference in SF-36 and HADS domain scores were found between patient with and without orthopaedic symptoms and patients with or without previous aortic surgery. Additionally, we found that patients' worries for their future and heredity of their disease are important factors for anxiety, which should be addressed in clinical practice.
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Affiliation(s)
- Lidia R Bons
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Allard T van den Hoven
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ayda E Damirchi
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Denise van der Linde
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Silvy Dekker
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Robert M Kauling
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ingrid M B H van de Laar
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Child Psychiatry the Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
| | - Ricardo P J Budde
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Abstract
PURPOSE OF REVIEW Summarize the literature on the social skills and relationships of women with Turner syndrome and examine the biological and psychological factors that may contribute to social interaction difficulties. RECENT FINDINGS Turner syndrome is often associated with impaired social-cognitive processing and executive function deficits. These cognitive abnormalities, together with a range of physical differences, may adversely affect social communication skills, which typically begin to impair quality of life during early adolescence. Parental accounts of their daughter's social skills frequently highlight interaction problems, both in the home and beyond; in contrast, self-reports are usually far more positive. At present, we do not know the extent to which such self-reports reflect a lack of social awareness, or a lack of concern about social difficulties. SUMMARY Women with Turner syndrome are likely to experience social interaction challenges (especially in friendships and relationships) across the lifespan. Providing appropriate guidance and support to them demands a better understanding of their strengths and weaknesses.
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Rovet JF, Van Vliet G. Growth Hormone Supplementation and Psychosocial Functioning to Adult Height in Turner Syndrome: A Questionnaire Study of Participants in the Canadian Randomized Trial. Front Endocrinol (Lausanne) 2019; 10:125. [PMID: 30930850 PMCID: PMC6425861 DOI: 10.3389/fendo.2019.00125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/11/2019] [Indexed: 11/13/2022] Open
Abstract
Despite the long-held belief that growth hormone supplementation provides psychosocial benefits to patients with Turner syndrome (TS), this assumption has never been rigorously tested in a randomized control trial. As a sub-study of the Canadian growth-hormone trial, parent-, and patient-completed standardized questionnaires were used to compare 70 girls with TS who received injections (GH group) and 61 similarly followed untreated TS controls (C) on multiple facets of psychosocial functioning. Questionnaires were given (i) at baseline (session 1, mean age = 10.4 y), (ii) before estrogen therapy for puberty induction (session 2, mean age = 13.0 y), (iii) after 1 year of estrogen therapy (session 3, mean age = 14.4 y), and (iv) when growth stopped (session 4, mean age = 16.3 y). Groups were compared for multiple facets of psychosocial function within social, behavioral, self-esteem, and academic domains. Results were also correlated with indices of adult height. We found no global (i.e., across-session) group differences on any scales or subscales of the four domains. In both GH and C groups, age-related improvements were seen for social problems, externalizing behavior problems, and school functioning and age-related declines for social competence and social relations. Both parents and patients claimed GH received less teasing than C but C had more friends than GH. Results from analyses conducted within individual sessions showed that while GH at early sessions claimed to be more popular, more socially engaged, better adapted, and to have higher self-esteem than C, C was reported to be less anxious, depressed, and withdrawn than GH at adult height. The correlation analyses revealed different effects of adult height and height gain on outcome for the two groups. In GH, both height parameters were correlated with multiple parent- and/or self-reported indices from the four psychosocial domains, whereas in C, only adult height and two indices (viz., total self-concept and school functioning), were correlated. The observed modest gains in psychosocial functioning for patients with TS treated with GH highlight the need for alternative approaches to assist them in coping with the challenges of their condition.
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Affiliation(s)
- Joanne F. Rovet
- Departments of Pediatrics and Psychology, University of Toronto, Toronto, ON, Canada
- Neuroscience and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada
- *Correspondence: Joanne F. Rovet
| | - Guy Van Vliet
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
- Endocrinology Service and Research Centre, CHU Sainte-Justine, Montreal, QC, Canada
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10
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Kosteria I, Kanaka-Gantenbein C. Turner Syndrome: transition from childhood to adolescence. Metabolism 2018; 86:145-153. [PMID: 29309748 DOI: 10.1016/j.metabol.2017.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 12/29/2017] [Accepted: 12/31/2017] [Indexed: 01/15/2023]
Abstract
Transition from pediatric to adult care for young women with Turner Syndrome (TS) is characterized by high drop-out rates and inadequate follow-up, leading to increased morbidity and mortality. The complexity of the health issues young women with TS face or new problems that may arise warrants a well-structured and efficiently coordinated gradual transition plan, which is adapted to the individual needs of the emerging young adult and is based on interdisciplinary communication between physicians. In order to achieve a high level of care, it is important for the patient to be sincerely informed about her condition but also supported throughout this critical period of rising responsibility and autonomy by an experienced, multidisciplinary team. In this review, we present the basic concepts that should characterize transition and the major health issues that should be thoroughly addressed, including growth, Hormone Replacement Treatment and fertility options, cardiovascular disease, bone health, gastrointestinal disorders, autoimmunity, orthopaedic and ENT issues, as well as the overall psychological well-being of the young adult with TS.
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Affiliation(s)
- Ioanna Kosteria
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, "Agia Sophia" Children's Hospital, Athens, Greece.
| | - Christina Kanaka-Gantenbein
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, "Agia Sophia" Children's Hospital, Athens, Greece
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11
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Psychosocial Characteristics of Women with a Delayed Diagnosis of Turner Syndrome. J Pediatr 2018; 199:206-211. [PMID: 29753544 PMCID: PMC6063780 DOI: 10.1016/j.jpeds.2018.03.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/21/2018] [Accepted: 03/22/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To characterize the psychosocial profiles of adult women diagnosed with Turner syndrome before (early diagnosis) and at or after (late diagnosis) 13 years of age. STUDY DESIGN Women with Turner syndrome ages 22 and older at evaluation (n = 110) participated in a cross-sectional study at the National Institutes of Health. Researchers performed nonparametric and logistic regression analyses to assess early and late diagnosis cohorts on measures of depression, substance use, and perceptions of competence and identity. RESULTS Of study participants, 47% received a Turner syndrome diagnosis at or after age 13 years. Median age at diagnosis was 12.0 years (range, 0-43). Covariate-adjusted models revealed that women with late diagnoses had an increased likelihood of developing mild to severe depressive symptoms (OR, 7.36) and a decreased likelihood of being perceived as competent (OR, 0.26). Women with a late diagnosis also exhibited more frequent substance use compared with women with early diagnoses. CONCLUSIONS These data suggest that Turner syndrome diagnoses received at or after age 13 years may contribute to adverse outcomes related to depression, substance use, and perceptions of competence. Delayed Turner syndrome diagnoses may place women and girls at risk for negative psychosocial development extending into adulthood. These findings indicate it is important for pediatricians to evaluate psychosocial domains in girls with Turner syndrome regularly, particularly among those diagnosed at age 13 years or older. TRIAL REGISTRATION ClinicalTrials.gov: NCT00006334.
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Hanew K, Tanaka T, Horikawa R, Hasegawa T, Yokoya S. Prevalence of diverse complications and its association with karyotypes in Japanese adult women with Turner syndrome-a questionnaire survey by the Foundation for Growth Science. Endocr J 2018. [PMID: 29515055 DOI: 10.1507/endocrj.ej17-0401] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The reported prevalence of complications in Turner Syndrome (TS) was highly variable because of the rarity and the limited numbers analyzed. Again, possible presence of other complications that are not described as specific for TS, is also speculated. To resolve these issues, a questionnaire survey was conducted in hGH treated 492 patients with adult TS (17-42 years). The possible association with these complications and karyotypes were also analyzed. The complications and their prevalence were as follows: chronic thyroiditis (25.2%), inflammatory bowel disease (1.8%), congenital cardiovascular anomaly (11.8%), urinary tract malformation (11.8%), low bone mineral density (BMD) (42.9%), scoliosis (8.4%), hearing loss (6.2%), epilepsy (2.8%) and schizophrenia (0.9%). The majority of prevalence of these diseases in TS was higher than in the general population. In distribution, the most frequent karyotype was 45,X monosomy (28.9%), followed by 45,X/46,X,Xi (16.9%), 46,X,Xi (9.1%), and 45,X/46,XX (6.3%), while other mosaic 45,X was noted in 29.9%. Regarding the karyotype, cardiovascular anomaly was more frequent in the 45,X group and less in the 46,X,Xi group. Urinary tract malformation and epilepsy were frequently associated with the chromosome 45,X. The prevalence of low BMD was noticed more in the chromosome 46,X,Xi and 45,X/46,X,Xi, and less in other mosaic 45,X. In conclusion, the more exact prevalence of diverse complications was clarified and it exceeded the prevalence of the majority of complications in general population. As novel findings, it was observed that the prevalence of epilepsy was significantly high, and epilepsy and low BMD were frequently associated with the specific karyotypes.
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Affiliation(s)
- Kunihiko Hanew
- Growth Hormone Therapy Research Committee, Foundation for Growth Science, Tokyo, Japan
| | - Toshiaki Tanaka
- Growth Hormone Therapy Research Committee, Foundation for Growth Science, Tokyo, Japan
| | - Reiko Horikawa
- Growth Hormone Therapy Research Committee, Foundation for Growth Science, Tokyo, Japan
| | - Tomonobu Hasegawa
- Growth Hormone Therapy Research Committee, Foundation for Growth Science, Tokyo, Japan
| | - Susumu Yokoya
- Growth Hormone Therapy Research Committee, Foundation for Growth Science, Tokyo, Japan
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Ertl DA, Gleiss A, Schubert K, Culen C, Hauck P, Ott J, Gessl A, Haeusler G. Health status, quality of life and medical care in adult women with Turner syndrome. Endocr Connect 2018; 7. [PMID: 29514898 PMCID: PMC5881433 DOI: 10.1530/ec-18-0053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Previous studies have shown that only a minority of patients with Turner syndrome (TS) have adequate medical care after transfer to adult care. AIM OF THIS STUDY To assess the status of medical follow-up and quality of life (QoL) in adult women diagnosed with TS and followed up until transfer. To compare the subjective and objective view of the medical care quality and initiate improvements based on patients' experiences and current recommendations. METHODS 39 adult women with TS out of 64 patients contacted were seen for a clinical and laboratory check, cardiac ultrasound, standardized and structured questionnaires (SF-36v2 and Beck depression inventory). RESULTS 7/39 of the patients were not being followed medically at all. Only 2/39 consulted all the specialists recommended. Comorbidities were newly diagnosed in 27/39 patients; of these, 11 related to the cardiovascular system. Patients in our cohort scored as high as the mean reference population for SF-36v2 in both mental and physical compartments. Obese participants had lower scores in the physical function section, whereas higher education was related to higher physical QoL scores. Adult height slightly correlated positively with physical health. CONCLUSION Medical follow-up was inadequate in our study cohort of adults with TS. Even though their medical follow-up was insufficient, these women felt adequately treated, leaving them vulnerable for premature illness. Initiatives in health autonomy and a structured transfer process as well as closer collaborations within specialities are urgently needed.
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Affiliation(s)
- Diana-Alexandra Ertl
- Department of PulmonologyAllergology and Endocrinology, University Clinic for Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Andreas Gleiss
- Center for Medical StatisticsInformatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Katharina Schubert
- Department of PulmonologyAllergology and Endocrinology, University Clinic for Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Caroline Culen
- Department of PulmonologyAllergology and Endocrinology, University Clinic for Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Peer Hauck
- Pediatric Heart Center ViennaUniversity Clinic for Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Johannes Ott
- Clinic Division for Gynecologic Endocrinology and Reproductive MedicineMedical University of Vienna, Vienna, Austria
| | - Alois Gessl
- Division of EndocrinologyUniversity Clinic of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Gabriele Haeusler
- Department of PulmonologyAllergology and Endocrinology, University Clinic for Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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Reis CT, de Assumpção MS, Guerra-Junior G, de Lemos-Marini SHV. Systematic review of quality of life in Turner syndrome. Qual Life Res 2018; 27:1985-2006. [DOI: 10.1007/s11136-018-1810-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
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Puce L, Marinelli L, Mori L, Pallecchi I, Trompetto C. Protocol for the study of self-perceived psychological and emotional well-being of young Paralympic athletes. Health Qual Life Outcomes 2017; 15:219. [PMID: 29132378 PMCID: PMC5683577 DOI: 10.1186/s12955-017-0798-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 11/07/2017] [Indexed: 11/12/2022] Open
Abstract
Background We present the detailed protocol set up to investigate how agonistic sport affects the self-perceived psychological and emotional well-being of disabled young people. Methods The study will be carried out on a number of subjects as large as 800–1200, using well-established indices that give a quantitative measure of such well-being, namely SF-12 and PGWBI. The related questionnaires will be administered to the participants to a forthcoming international event, the European Para-Youth Games, 9–15 October 2017, Liguria, Italy, as well as to a reference population of a similar number of subjects, made up of young disabled people that do not practice agonistic sport. Discussion We expect that the outcomes of the study may strongly impact not only the socio-sanitary field but also society in general, as disabled people can be considered an extreme situation in the issue of balancing individual needs and environment to pursue psychological well-being. Trial registration ISRCTN14389453 (29 June 2017).
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Affiliation(s)
- Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Genoa, Italy.
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Genoa, Italy
| | - Laura Mori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Genoa, Italy
| | | | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Genoa, 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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17
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Culen C, Ertl DA, Schubert K, Bartha-Doering L, Haeusler G. Care of girls and women with Turner syndrome: beyond growth and hormones. Endocr Connect 2017; 6:R39-R51. [PMID: 28336768 PMCID: PMC5434744 DOI: 10.1530/ec-17-0036] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/22/2017] [Indexed: 01/10/2023]
Abstract
Turner syndrome (TS), although considered a rare disease, is the most common sex chromosome abnormality in women, with an incident of 1 in 2500 female births. TS is characterized by distinctive physical features such as short stature, ovarian dysgenesis, an increased risk for heart and renal defects as well as a specific cognitive and psychosocial phenotype. Given the complexity of the condition, patients face manifold difficulties which increase over the lifespan. Furthermore, failures during the transitional phase to adult care result in moderate health outcomes and decreased quality of life. Guidelines on the optimal screening procedures and medical treatment are easy to find. However, recommendations for the treatment of the incriminating psychosocial aspects in TS are scarce. In this work, we first reviewed the literature on the cognitive and psychosocial development of girls with TS compared with normal development, from disclosure to young adulthood, and then introduce a psychosocial approach to counseling and treating patients with TS, including recommendations for age-appropriate psychological diagnostics. With this work, we aim to facilitate the integration of emphasized psychosocial care in state-of-the-art treatment for girls and women with TS.
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Affiliation(s)
- Caroline Culen
- University Clinic of Pediatrics and Adolescent MedicineMedical University of Vienna, Vienna, Austria
| | - Diana-Alexandra Ertl
- University Clinic of Pediatrics and Adolescent MedicineMedical University of Vienna, Vienna, Austria
| | - Katharina Schubert
- University Clinic of Pediatrics and Adolescent MedicineMedical University of Vienna, Vienna, Austria
| | - Lisa Bartha-Doering
- University Clinic of Pediatrics and Adolescent MedicineMedical University of Vienna, Vienna, Austria
| | - Gabriele Haeusler
- University Clinic of Pediatrics and Adolescent MedicineMedical University of Vienna, Vienna, Austria
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18
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Freriks K, Verhaak CM, Sas TCJ, Menke LA, Wit JM, Otten BJ, de Muinck Keizer-Schrama SMPF, Smeets DFCM, Netea-Maier RT, Hermus ARMM, Kessels RPC, Timmers HJLM. Long-term effects of oxandrolone treatment in childhood on neurocognition, quality of life and social-emotional functioning in young adults with Turner syndrome. Horm Behav 2015; 69:59-67. [PMID: 25562712 DOI: 10.1016/j.yhbeh.2014.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 11/28/2014] [Accepted: 12/23/2014] [Indexed: 11/24/2022]
Abstract
Turner syndrome (TS) is the result of (partial) absence of one X-chromosome. Besides short stature, gonadal dysgenesis and other physical aspects, TS women have typical psychological features. Since psychological effects of androgen exposure in childhood probably are long-lasting, we explored long-term psychological functioning after oxandrolone (Ox) therapy during childhood in adults with TS in terms of neurocognition, quality of life and social-emotional functioning. During the initial study, girls were treated with growth hormone (GH) combined with placebo (Pl), Ox 0.03 mg/kg/day, or Ox 0.06 mg/kg/day from the age of eight, and estrogen from the age of twelve. Sixty-eight women participated in the current double-blinded follow-up study (mean age 24.0 years, mean time since stopping GH/Ox 8.7 years). We found no effects on neurocognition. Concerning quality of life women treated with Ox had higher anxiety levels (STAI 37.4 ± 8.4 vs 31.8 ± 5.0, p=0.002) and higher scores on the depression subscale of the SCL-90-R (25.7 ± 10.7 vs 20.5 ± 4.7, p=0.01). Regarding social-emotional functioning, emotion perception for fearful faces was lower in the Ox-treated patients, without effect on interpersonal behavior. Our exploratory study is the first to suggest that androgen treatment in adolescence possibly has long-term effects on adult quality of life and social-emotional functioning. However, differences are small and clinical implications of our results seem limited. Therefore we would not recommend against the use of Ox in light of psychological consequences.
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Affiliation(s)
- K Freriks
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 471, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - C M Verhaak
- Department of Medical Psychology, Radboud University Medical Center, 118/925, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - T C J Sas
- Department of Pediatrics, Erasmus Medical Centre/Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands; Department of Pediatrics, Albert Schweitzer Hospital, P.O. Box 444, 3300 AK Dordrecht, The Netherlands
| | - L A Menke
- Department of Pediatrics, Leiden University Medical Center, J6S, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - J M Wit
- Department of Pediatrics, Leiden University Medical Center, J6S, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - B J Otten
- Department of Pediatrics, Radboud University Medical Center, 804, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - S M P F de Muinck Keizer-Schrama
- Department of Pediatrics, Erasmus Medical Centre/Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands
| | - D F C M Smeets
- Department of Human Genetics, Radboud University Medical Center, 848, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - R T Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 471, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - A R M M Hermus
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 471, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - R P C Kessels
- Department of Medical Psychology, Radboud University Medical Center, 118/925, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, The Netherlands
| | - H J L M Timmers
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 471, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Abstract
Girls and women with Turner's syndrome who come to medical attention older than 12 years present a challenge of medical management. Puberty is already delayed and some compromises have to be made in adjusting the timing of artificially induced puberty to optimise overall outcome with respect to stature, secondary sex characteristics, and psychosocial endpoints. Additionally, individuals who present with primary amenorrhoea to adult services might miss the opportunity for effective growth hormone treatment. Further, induction of puberty regimens lack an evidence base or even clear guidelines for the timing and dose of oestrogen replacement. We have searched the scientific literature to inform management of Turner's syndrome.
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Affiliation(s)
- Marilyn Cheng Lee
- Institute for Women's Health, University College London, London, UK.
| | - Gerard S Conway
- Institute for Women's Health, University College London, London, UK
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20
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Turner syndrome: advances in understanding altered cognition, brain structure and function. Curr Opin Neurol 2012; 25:144-9. [PMID: 22322416 DOI: 10.1097/wco.0b013e3283515e9e] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Turner syndrome, which results from the complete or partial loss of a sex chromosome, is associated with a particular pattern of cognitive impairments and strengths and an increased risk for specific neurodevelopmental disorders. This review highlights recent progress in understanding brain structure and function in Turner syndrome and identifies several critical research needs. RECENT FINDINGS Recent work on social cognition in Turner syndrome has identified a range of difficulties despite a maintained social appetite, a disconnect which could result in distress for affected individuals. Progress has been made in identifying foundational deficits in attention and executive function that could explain visual-spatial and arithmetical impairments. Neuroimaging studies have advanced our understanding of brain development and function through the application of cutting edge analysis techniques. Haploinsufficiency of genes, failure to express parentally imprinted genes, uncovering of X chromosome mutations, and gonadal steroid deficiency may all contribute to altered brain development, but additional work is required to link specific mechanisms to specific phenotypes. Also needed are studies of interventions to assist individuals with Turner syndrome in visual-spatial, mathematical, and social skills. SUMMARY Ultimately a better understanding of brain structure and function in Turner syndrome will generate new therapeutic approaches for this population.
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Knickmeyer RC, Davenport M. Turner syndrome and sexual differentiation of the brain: implications for understanding male-biased neurodevelopmental disorders. J Neurodev Disord 2011; 3:293-306. [PMID: 21818630 PMCID: PMC3261262 DOI: 10.1007/s11689-011-9089-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 07/13/2011] [Indexed: 01/24/2023] Open
Abstract
Turner syndrome (TS) is one of the most common sex chromosome abnormalities. Affected individuals often show a unique pattern of cognitive strengths and weaknesses and are at increased risk for a number of other neurodevelopmental conditions, many of which are more common in typical males than typical females (e.g., autism and attention-deficit hyperactivity disorder). This phenotype may reflect gonadal steroid deficiency, haploinsufficiency of X chromosome genes, failure to express parentally imprinted genes, and the uncovering of X chromosome mutations. Understanding the contribution of these different mechanisms to outcome has the potential to improve clinical care for individuals with TS and to better our understanding of the differential vulnerability to and expression of neurodevelopmental disorders in males and females. In this paper, we review what is currently known about cognition and brain development in individuals with TS, discuss underlying mechanisms and their relevance to understanding male-biased neurodevelopmental conditions, and suggest directions for future research.
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Affiliation(s)
- Rebecca Christine Knickmeyer
- Department of Psychiatry CB 7160, University of North Carolina at Chapel Hill, 343 Medical Wings C, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA,
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Naess EE, Bahr D, Gravholt CH. Health status in women with Turner syndrome: a questionnaire study on health status, education, work participation and aspects of sexual functioning. Clin Endocrinol (Oxf) 2010; 72:678-84. [PMID: 19769615 DOI: 10.1111/j.1365-2265.2009.03715.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
CONTEXT Turner syndrome (TS) is a complex medical condition with specific cognitive and psychosocial characteristics and frequent medical morbidity. Few studies have investigated the influence this has on health status, education and ability to work. OBJECTIVE To explore health status, level of education, work participation, medical conditions, physical activity, satisfaction with life and aspects of sexual functioning in adult TS women and compare with a matched control group. DESIGN A questionnaire was sent to 168 adult women with TS >18 years registered in a database of Frambu Resource Centre for Rare Disorders and The TS Association in Norway. We assessed health status with Short Form 36, education with Norwegian Standard Classification of Education, and employment with The General Nordic Questionnaire. Life satisfaction was measured with LiSat-9, and questions on psychological strain during life phases were included. RESULTS Eighty women with TS (34.0 +/- 11.7 years) and 214 controls (32.9 +/- 10.6) responded. The TS group reported significantly more health problems and impaired health status in the two subscales "physical functioning" and "general health" (P < 0.001). Level of education and work participation was similar among TS and controls. TS moved away from their parents' home later than controls (20.4 +/- 4.0 vs. 18.7 +/- 2.1, P = 0.001). Age at sexual debut differed significantly (21.2 +/- 4.3 vs. 17.3 +/- 2.4 years, P < 0.001). CONCLUSION TS attains the same level of education and level of employment as controls, they report more frequent occurrence of medical conditions, but scored lower on only two subscales in the SF-36. Despite considerable medical morbidity, TS seem to cope well with life.
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Abstract
OBJECTIVE To highlight the importance of an improved, seamless, and effective transition from pediatric to adult care, especially for medically complex conditions such as Turner syndrome (TS). METHODS The morbidities in adult patients with TS are reviewed, including features of the metabolic syndrome, congenital and acquired cardiovascular conditions, osteopenia and osteoporosis, autoimmune thyroid disease, and obesity, and psychobehavioral issues are addressed, in terms of promoting the development of independent self-care and autonomy in adolescent patients. RESULTS An essential component of high-quality health care, transition for adolescents with TS needs to be reengineered as a staged process initiated during early-stage adolescence (about age 12 years), when exogenous estrogen therapy is begun in coordination with the final phase of growth hormone therapy. At this time, the focus of care shifts from the parent to the adolescent and from maximizing final adult height to inducing puberty with gradually increasing doses of estrogen. During this transition, the development of healthful and independent healthcare behaviors should be promoted to prepare patients with TS for the adult responsibility of self-care. During the final phase of transition, an adult care plan should be formulated in collaboration with the adolescent with TS and her providers of adult care to improve the likelihood that she will continue to be carefully monitored in a way that optimizes her adult health and longevity. CONCLUSION The transitional period from pediatrics to adulthood is the ideal time for patients with TS to be made aware of their health history and health needs and of the evolving impact of TS into adulthood.
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Affiliation(s)
- Karen R Rubin
- Connecticut Children's Medical Center, Hartford, CT 06106, USA
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López MC, Aguilar MJ. Vulnerabilidad social en el síndrome de turner: interacción genes-ambiente. PSICOLOGIA: CIÊNCIA E PROFISSÃO 2009. [DOI: 10.1590/s1414-98932009000200009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
En este trabajo se exponen los fundamentos teóricos que permiten considerar al Síndrome de Turner como un “modelo genético sensible” en el cual analizar asociaciones entre caracteres psicológicos y factores genéticos y ambientales. La investigación en esta línea permitiría dilucidar mecanismos de riesgo ambiental y comprender el grado de “vulnerabilidad” que presentan las mujeres con el síndrome. El Síndrome de Turner es un trastorno genético, no heredable, que se caracteriza por la deleción total o parcial del cromosoma X en el sexo femenino. El estudio de la disfunción social que presentan las mujeres con este síndrome, es decir, de la capacidad para relacionarse con el entorno y la calidad de los vínculos tiene importantes implicaciones en la comprensión de la forma en que actúa el ambiente sobre el desarrollo psicológico, y de cómo a su vez éste se ve afectado por factores genéticos que actúan en interacción.
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Christopoulos P, Deligeoroglou E, Laggari V, Christogiorgos S, Creatsas G. Psychological and behavioural aspects of patients with Turner syndrome from childhood to adulthood: a review of the clinical literature. J Psychosom Obstet Gynaecol 2008; 29:45-51. [PMID: 17852655 DOI: 10.1080/01674820701577078] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Turner syndrome (TS) is a chromosomal abnormality, which occurs in approximately one of every 2500 female births. Short stature, infertility, additional physical abnormalities, skeletal and medical problems may be present. Genetic, hormonal, and medical problems associated with TS are likely to affect psychosexual development of female adolescent patients, and thus influence their psychological functioning, behavior patterns, social interactions and learning ability. Although TS constitutes a chronic medical condition, with possible physical, social and psychological complications in a woman's life, hormonal and estrogen replacement therapy and assisted reproduction, are treatments that can be helpful for TS patients and improve their quality of life. Authors report on a review of the research literature clinical aspects of the syndrome as well as the beneficial effect of hormonal therapy in such patients.
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Affiliation(s)
- P Christopoulos
- 2nd Department of Obstetrics and Gynecology, Medical School, University of Athens, Aretaieion Hospital, Greece.
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Sheaffer AT, Lange E, Bondy CA. Sexual Function in Women with Turner Syndrome. J Womens Health (Larchmt) 2008; 17:27-33. [DOI: 10.1089/jwh.2007.0488] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alexis T. Sheaffer
- Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Eileen Lange
- Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Carolyn A. Bondy
- Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Rolstad SG, Möller A, Bryman I, Boman UW. Sexual functioning and partner relationships in women with turner syndrome: some empirical data and theoretical considerations regarding sexual desire. JOURNAL OF SEX & MARITAL THERAPY 2007; 33:231-47. [PMID: 17454521 DOI: 10.1080/00926230701267886] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The aim of this study was to describe marital status, sexual history, and sexual functioning in a group of women with Turner syndrome, and to compare the results with general Swedish population data. The sample consists of 57 women over 18 years of age. Data were collected from an interview, and using two self-report questionnaires: the McCoy Sexual Rating Scale and the Relationship Rating Scale (RS). Compared to population data, the women with Turner syndrome were less likely to have a partner and had had their sexual debut later. Single women differed more from the general population than did women with a partner, regarding sexual desire and sexual activity. Several women with a partner reported sexual problems, but unanimously reported being satisfied with their sex life and partner relationship. The level of sexual desire in women with Turner syndrome is discussed in relation to Levine's model of human sexual desire, where psychological and social motivational factors are considered in addition to a biologically based sexual drive (Levine, 1992).
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Lagrou K, Froidecoeur C, Verlinde F, Craen M, De Schepper J, François I, Massa G. Psychosocial functioning, self-perception and body image and their auxologic correlates in growth hormone and oestrogen-treated young adult women with Turner syndrome. HORMONE RESEARCH 2006; 66:277-84. [PMID: 16946621 DOI: 10.1159/000095547] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Accepted: 07/11/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Few data are available on the psychosocial status of growth hormone (GH) and oestrogen treated women with Turner syndrome (TS). In this study, we evaluated psychosocial functioning, self-concept and body image in GH and oestrogen treated young adult women with TS and we studied the relationship with auxological parameters. PATIENTS AND METHODS Thirty women with TS (mean +/- SD age: 22.1 +/- 2.4 years), all treated with GH and oestrogens if indicated, and an age-matched reference group of 44 non-Turner female students (age: 20.5 +/- 2.1 years) completed 3 questionnaires evaluating, respectively, behavioural and emotional problems (Young Adult Self Report), self-concept (Self Perception Profile for College Students) and body-image (Body Attitude Scale). RESULTS TS patients did not report more behavioural and emotional problems compared to the non-TS females except for attention problems; they even reported fewer problems on some subscales (somatic complaints, thought problems, delinquent behaviour). TS patients did not differ from the non-TS female group in their bodily satisfaction. TS patients, particularly patients with a 45,X karyotype, perceived themselves as less socially competent. BMI was significantly related to the appraisal score of the Body Attitude Scale, whereas height was not related to any of the evaluated psychosocial parameters. CONCLUSION The psychosocial adaptation of young adult women with TS, diagnosed at an early age and treated during childhood with GH and oestrogens if indicated, appears to be quite satisfactory. Follow-up of adult TS patients should not neglect the problem of overweight and associated psychosocial consequences.
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Affiliation(s)
- Katrien Lagrou
- Belgian Study Group of Paediatric Endocrinology (BSGPE), Department of Paediatric Endocrinology, University of Gent, Belgium
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