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Aversa T, De Sanctis L, Faienza MF, Gambineri A, Balducci A, D'Aprile R, Di Somma C, Giavoli C, Grossi A, Meriggiola MC, Profka E, Salerno M, Stagi S, Scarano E, Zatelli MC, Wasniewska M. Transition from pediatric to adult care in patients with Turner syndrome in Italy: a consensus statement by the TRAMITI project. J Endocrinol Invest 2024; 47:1585-1598. [PMID: 38376731 PMCID: PMC11196323 DOI: 10.1007/s40618-024-02315-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Transition from pediatric to adult care is associated with significant challenges in patients with Turner syndrome (TS). The objective of the TRansition Age Management In Turner syndrome in Italy (TRAMITI) project was to improve the care provided to patients with TS by harnessing the knowledge and expertise of various Italian centers through a Delphi-like consensus process. METHODS A panel of 15 physicians and 1 psychologist discussed 4 key domains: transition and referral, sexual and bone health and oncological risks, social and psychological aspects and systemic and metabolic disorders. RESULTS A total of 41 consensus statements were drafted. The transition from pediatric to adult care is a critical period for patients with TS, necessitating tailored approaches and early disclosure of the diagnosis to promote self-reliance and healthcare autonomy. Fertility preservation and bone health strategies are recommended to mitigate long-term complications, and psychiatric evaluations are recommended to address the increased prevalence of anxiety and depression. The consensus also addresses the heightened risk of metabolic, cardiovascular and autoimmune disorders in patients with TS; regular screenings and interventions are advised to manage these conditions effectively. In addition, cardiac abnormalities, including aortic dissections, require regular monitoring and early surgical intervention if certain criteria are met. CONCLUSIONS The TRAMITI consensus statement provides valuable insights and evidence-based recommendations to guide healthcare practitioners in delivering comprehensive and patient-centered care for patients with TS. By addressing the complex medical and psychosocial aspects of the condition, this consensus aims to enhance TS management and improve the overall well-being and long-term outcomes of these individuals.
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Affiliation(s)
- T Aversa
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
- Pediatric Unit, University Hospital "G. Martino", Via Consolare Valeria N. 1, 98124, Messina, Italy
| | - L De Sanctis
- Pediatric Endocrinology, Regina Margherita Children Hospital, Turin, Italy
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - M F Faienza
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - A Gambineri
- Division of Endocrinology and Diabetes Prevention and Care, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy
| | - A Balducci
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio - Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero - Universitaria Di Bologna, Bologna, Italy
| | - R D'Aprile
- Department of Women's and Children's Health, University of Padua, Padua, Italy
- A.Fa.D.O.C. Association OdV, Vicenza, Italy
| | - C Di Somma
- Unit of Endocrinology, AOU Federico II, Naples, Italy
| | - C Giavoli
- Endocrinology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Grossi
- Endocrine Pathology of Chronic and Post-Tumor Diseases Unit, "Bambino Gesù" Pediatric Hospital, Rome, Italy
| | - M C Meriggiola
- Division of Gynecology and Physiopathology of Reproduction, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy
| | - E Profka
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Salerno
- Pediatric Section, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - S Stagi
- Health Sciences Department, University of Florence, Florence, Italy
- Meyer Children's Hospital IRCCS, Florence, Italy
| | - E Scarano
- Pediatric Unit, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy
| | - M C Zatelli
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - M Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy.
- Pediatric Unit, University Hospital "G. Martino", Via Consolare Valeria N. 1, 98124, Messina, Italy.
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Singh P, Seth A. Transition of Care of Pediatric Patients with Special Needs to Adult Care Settings: Children with Diabetes Mellitus and Other Endocrine Disorders. Indian J Pediatr 2023; 90:1134-1141. [PMID: 37542570 DOI: 10.1007/s12098-023-04780-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 07/12/2023] [Indexed: 08/07/2023]
Abstract
Childhood onset endocrine disorders need long-term medical, psychological and social management. Over time, many illnesses evolve, while others may witness onset of new complications. Thus, the components of the care change as the child grows into adolescence and then adulthood. The transition of children and adolescents with chronic endocrine disorders to adult care continues to be a major challenge. Pediatric and adult healthcare teams should together design a transitional care plan that is developmentally appropriate and responsive to the needs of young adults. The preparation for transition to adult care should begin early in adolescence and involve both the adolescent and his parents. A structured and planned transitional care bridges the gap between pediatric and adult care teams, promote ongoing engagement and build trust with the new healthcare teams. Combined pediatric-adult care transition model for endocrine conditions has yielded high adherence rates and patient satisfaction.
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Affiliation(s)
- Preeti Singh
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Anju Seth
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India.
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Younger K, Malhotra K, Clark HD, Kelly K. An interprofessional clinic for adults with Turner syndrome: the patient perspective. Climacteric 2022; 25:609-614. [PMID: 36183703 DOI: 10.1080/13697137.2022.2122428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This qualitative study assessed the value of a primary care-based interprofessional clinical team for adults with Turner syndrome (TS) utilizing patient perspectives. METHODS Ten patients within one institution's interprofessional adult TS clinic participated in one of two semi-structured focus groups. Content analysis was used to classify content provided by participants into themes and sub-themes using Dedoose software. RESULTS Participants found that their quality of care and life were both improved due to the presence of the interprofessional Adults with TS Clinic. Specifically, participants reported that the clinic helped address problems with finding knowledgeable providers and care gaps, made appointments more convenient and improved interprofessional communication. Participants also reported that the clinic helped them find a sense of community and increased personal confidence. Study participants suggested improvements to the clinic by expanding the scope of practice further, simplifying processes to schedule appointments, and potentially creating interprofessional clinics for other rare diseases as well. CONCLUSION Pursuing avenues to create interprofessional clinics for adults with rare diseases has value from the patient perspective. This value can translate to improved patient outcomes through improvements in patient knowledge of their diagnosis, adherence to evidence-based care and quality of life.
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Affiliation(s)
- K Younger
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - K Malhotra
- Department of Family Medicine and Community Health, Northwestern University, Chicago, IL, USA
| | - H D Clark
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - K Kelly
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS, USA
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Kim J, Kim MS, Suh BK, Ko CW, Lee KH, Yoo HW, Shin CH, Hwang JS, Kim HS, Chung WY, Kim CJ, Han HS, Jin DK. Recombinant growth hormone therapy in children with Turner Syndrome in Korea: a phase III Randomized Trial. BMC Endocr Disord 2021; 21:243. [PMID: 34893062 PMCID: PMC8662840 DOI: 10.1186/s12902-021-00904-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Short stature is the most consistent characteristic feature of Turner syndrome (TS). To improve final heights of children with TS effectively, it is important to provide them with early and appropriate treatment using growth hormone (GH). The objective of this study was to assess the efficacy and safety of a new recombinant human GH, Growtropin®-II (DA-3002, Dong-A ST Co., Ltd) versus a comparator (Genotropin®, Pfizer Inc.) for Korean children with TS. METHODS This open-label, active-controlled, parallel-group, randomized controlled phase III trial was conducted at 11 hospitals in Korea. Eligible patients (n = 58) were randomized to two groups: 1) DA-3002 group (administrated with DA-3002 at 0.14 IU [0.0450-0.050 mg] /kg/day); and 2) comparator group (administrated with the comparator at 0.14 IU [0.0450-0.050 mg] /kg/day). RESULTS The change from baseline in annualized height velocity (HV) after a 52-week treatment period was 4.15 ± 0.30 cm/year in the DA-3002 group and 4.34 ± 0.29 cm/year in the comparator group. The lower bound of 95% two-sided confidence interval for group difference in the change of annualized HV (- 1.02) satisfied the non-inferiority margin (- 1.5). The change in height standard deviation score (HtSDS) at 52-week was 0.70 ± 0.23 for the DA-3002 group and 0.66 ± 0.39 for the comparator group, showing no significant (p = 0.685) difference between the two groups. The change of skeletal maturity defined as change in bone age/change in chronological age between the two groups was not significantly different (1.25 ± 0.58 for the DA-3002 group and 1.47 ± 0.45 for the comparator group, p = 0.134). Changes from baseline in serum insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) after 52 weeks of treatment did not differ significantly between the two groups (p = 0.565 and p = 0.388, respectively) either. The occurrence of adverse events was not statistically different between groups. CONCLUSIONS This study demonstrates that the efficacy and safety of GH treatment with DA-3002 in children with TS are comparable with those of the comparator. It is expected to analysis the long-term effect of DA-3002 on the increase of final adult height in children with TS and possible late-onset complications in the future. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov. ClinicalTrials.gov identifier: NCT01813630 (19/03/2013).
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Affiliation(s)
- Jinsup Kim
- Department of Pediatrics, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, South Korea
| | - Min-Sun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, South Korea
| | - Byung-Kyu Suh
- Department of Pediatrics, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Cheol Woo Ko
- Department of Pediatrics, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Kee-Hyoung Lee
- Department of Pediatrics, Korea University Anam Hospital, Seoul, South Korea
| | - Han-Wook Yoo
- Department of Pediatrics, Medical Genetics Clinic and Laboratory, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Jin Soon Hwang
- Department of Pediatrics, Ajou University Hospital, Suwon, South Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Woo Yeong Chung
- Department of Pediatrics, Inje University Busan Paik Hospital, Busan, South Korea
| | - Chan Jong Kim
- Department of Pediatrics, Chonnam National University Hospital, Gwangju, South Korea
| | - Heon-Seok Han
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, South Korea
| | - Dong-Kyu Jin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, South Korea.
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García-Miñaúr S, Burkitt-Wright E, Verloes A, Shaikh G, Lebl J, Östman-Smith I, Wolf CM, Ortega Castelló E, Tartaglia M, Zenker M, Edouard T. European Medical Education Initiative on Noonan syndrome: A clinical practice survey assessing the diagnosis and clinical management of individuals with Noonan syndrome across Europe. Eur J Med Genet 2021; 65:104371. [PMID: 34757053 DOI: 10.1016/j.ejmg.2021.104371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Noonan syndrome (NS) is a rare genetic disorder caused by mutations in genes encoding components of the RAS/mitogen-activated protein kinase (MAPK) signalling pathway. Patients with NS exhibit certain characteristic features, including cardiac defects, short stature, distinctive facial appearance, skeletal abnormalities, cognitive deficits, and predisposition to certain cancers. Here, a clinical practice survey was developed to learn more about differences in the diagnosis and management of this disease across Europe. The aim was to identify gaps in the knowledge and management of this rare disorder. MATERIALS AND METHODS The European Medical Education Initiative on NS, which comprised a group of 10 experts, developed a 60-question clinical practice survey to gather information from European physicians on the diagnosis and clinical management of patients with diseases in the NS phenotypic spectrum. Physicians from three specialities (clinical genetics, paediatric endocrinology, paediatric cardiology) were invited to complete the survey by several national and European societies. Differences in answers provided by respondents between specialities and countries were analysed using contingency tables and the Chi-Squared test for independence. The Friedman's test was used for related samples. RESULTS Data were analysed from 364 respondents from 20 European countries. Most respondents came from France (21%), Spain (18%), Germany (16%), Italy (15%), United Kingdom (8%) and the Czech Republic (6%). Respondents were distributed evenly across three specialities: clinical genetics (30%), paediatric endocrinology (40%) and paediatric cardiology (30%). Care practices were generally aligned across the countries participating in the survey. Delayed diagnosis did not emerge as a critical issue, but certain unmet needs were identified, including transition of young patients to adult medical services and awareness of family support groups. CONCLUSION Data collected from this survey provide a comprehensive summary of the diagnosis and clinical management practices for patients with NS across different European countries.
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Affiliation(s)
- Sixto García-Miñaúr
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz Research Institute (IdiPAZ), Hospital Universitario La Paz, Madrid, Spain.
| | - Emma Burkitt-Wright
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust and University of Manchester, Manchester, UK
| | - Alain Verloes
- Department of Genetics, Hospital Robert Debré, Assistance Publique des Hopitaux de Paris (AP-HP), Paris, France
| | - Guftar Shaikh
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Jan Lebl
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Ingegerd Östman-Smith
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Cordula M Wolf
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Eduardo Ortega Castelló
- Department of Statistics and Data Science, Faculty of Statistical Studies, Complutense University of Madrid, Madrid, Spain
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Martin Zenker
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - Thomas Edouard
- Endocrine, Bone Diseases, and Genetics Unit, Children's Hospital, Toulouse University Hospital, RESTORE INSERM UMR1301, Toulouse, France
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Hanew K, Tanaka T, Horikawa R, Hasegawa T, Yokoya S. The current status of 492 adult women with Turner syndrome: a questionnaire survey by the Foundation for Growth Science. Endocr J 2021; 68:1081-1089. [PMID: 33907067 DOI: 10.1507/endocrj.ej20-0617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
Current status and its background of Adult Turner Syndrome (TS) are not clarified well. Via a questionnaire survey of 492 adult women with TS, this study investigated the association between menstruation, Kaufmann therapy (menstrual induction therapy), social status (education, employment & marriage), complications, transition from pediatric to adult care, and sex chromosome karyotype using statistical methods. Spontaneous menarche occurred in 22.0% and more frequently among patients with the 45,X/46,XX karyotype. Over 60% of these subjects, menstruation did not persist regularly. Kauffmann therapy was performed in 69.4%; the most common formulation was a conjugated estrogen and progesterone combination. Marriage and higher education advancement rates were low in adults with TS, whereas their employment rate was similar to that of the age-matched general female population. Patients receiving Kauffmann therapy had higher complication rates, greater education length, and higher employment rates. The higher-education advancement rate was observed among patients with 45,X/46,X,Xi and 46,X,Xi karyotypes. Transition from pediatrician to adult specialist was not smooth, subjects were treated in pediatric departments (60.7%), gynecological department (21.4%), internal medicine departments (13.3%), and others. While reason is not clear, the largest number of TS patients are treated in general pediatrics and the percentage of receiving Kauffmann therapy and having complication were significantly lower than in pediatric and adult department of endocrinology (& metabolism). This Study revealed many novel findings of adult TS.
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Affiliation(s)
- Kunihiko Hanew
- Growth Hormone Therapy Research Committee, Foundation for Growth Science, Tokyo 113-0033, Japan
| | - Toshiaki Tanaka
- Growth Hormone Therapy Research Committee, Foundation for Growth Science, Tokyo 113-0033, Japan
| | - Reiko Horikawa
- Growth Hormone Therapy Research Committee, Foundation for Growth Science, Tokyo 113-0033, Japan
| | - Tomonobu Hasegawa
- Growth Hormone Therapy Research Committee, Foundation for Growth Science, Tokyo 113-0033, Japan
| | - Susumu Yokoya
- Growth Hormone Therapy Research Committee, Foundation for Growth Science, Tokyo 113-0033, Japan
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Tulay P, Ergoren MC, Alkaya A, Yayci E, Sag SO, Temel SG. Inconsistency of Karyotyping and Array Comparative Genomic Hybridization (aCGH) in a Mosaic Turner Syndrome Case. Glob Med Genet 2021; 7:128-132. [PMID: 33693446 PMCID: PMC7938938 DOI: 10.1055/s-0041-1722974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Purpose
Turner syndrome is a sex chromosomal aberration where majority of the patients have 45,X karyotype, while several patients are mosaic involving 45,X/46,XX; 46,X,i(Xq); and other variants. Cytogenetic analysis, karyotyping, is considered to be the “gold standard” to detect numerical and structural chromosomal abnormalities. In the recent years, alternative approaches, such as array comparative genomic hybridization (aCGH), have been widely used in genetic analysis to detect numerical abnormalities as well as unbalanced structural rearrangements. In this study, we report the use of karyotyping as well as aCGH in detecting a possible Turner syndrome variant.
Methods
An apparent 16-year-old female was clinically diagnosed as Turner syndrome with premature ovarian failure and short stature. The genetic diagnosis was performed for the patient and the parents by karyotyping analysis. aCGH was also performed for the patient.
Main Findings
Cytogenetic analysis of the patient was performed showing variant Turner syndrome (46,X,i(X)(q10)[26]/46,X,del(X)(q11.2)[11]/45,X[8]/46,XX[5]). The patient's aCGH result revealed that she has a deletion of 57,252kb of Xp22.33-p11.21 region; arr[GRCh37] Xp22.33-p11.21 (310,932–57,563–078)X1. Both aCGH and fluorescence in situ hybridization (FISH) results suggested that
short stature Homeobox-containing
(
SHOX
) gene, which is located on Xp22.33, was deleted, though FISH result indicated that this was in a mosaic pattern.
Conclusion
In the recent years, aCGH has become the preferred method in detecting numerical abnormalities and unbalanced chromosomal rearrangements. However, its use is hindered by its failure of detecting mosaicism, especially low-level partial mosaicism. Therefore, although the resolution of the aCGH is higher, the cytogenetic investigation is still the first in line to detect mosaicism.
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Affiliation(s)
- Pinar Tulay
- Near East University, Faculty of Medicine, Department of Medical Genetics, Nicosia, Cyprus.,Near East University, DESAM Institute, Nicosia, Cyprus
| | - Mahmut Cerkez Ergoren
- Near East University, Faculty of Medicine, Department of Medical Genetics, Nicosia, Cyprus.,Near East University, DESAM Institute, Nicosia, Cyprus
| | - Ahmet Alkaya
- Bilecik Seyh Edebali University, Graduate School of Applied Sciences, Gulumbe Yerleskesi, Bilecik, Turkey
| | - Eyup Yayci
- Near East University, Faculty of Medicine, Department of Gynecology and Obstetrics, Nicosia, Cyprus
| | - Sebnem Ozemri Sag
- Uludag University, Faculty of Medicine, Department of Medical Genetics, Bursa, Turkey
| | - Sehime Gulsum Temel
- Uludag University, Faculty of Medicine, Department of Medical Genetics, Bursa, Turkey.,Uludag University, Faculty of Medicine, Department of Histology and Embryology, Bursa, Turkey
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Obara-Moszynska M, Dzialach L, Rabska-Pietrzak B, Niedziela M, Kapczuk K. Uterine Development During Induced Puberty in Girls with Turner Syndrome. Front Endocrinol (Lausanne) 2021; 12:707031. [PMID: 34295308 PMCID: PMC8290974 DOI: 10.3389/fendo.2021.707031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/17/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Most girls and women with Turner syndrome (TS) require estrogen replacement therapy (ERT) to initiate or maintain pubertal development. Most likely, the most fundamental effect of ERT in hypogonadism is the promotion of uterine growth. The optimal ERT model is still being discussed. The present study aimed to assess uterine size in girls with TS in the prepubertal state during and after the induction of puberty and compare it to a healthy population. METHODS The analysis encompassed 40 TS girls. The prepubertal and postpubertal control groups contained 20 healthy girls each. All patients with TS were treated with 17-ß estradiol. Uterine imaging was performed with two-dimensional (2D) transabdominal ultrasound. The uterine volume (UV) and fundocervical antero-posterior ratio (FCR) were calculated in patients with TS before the pubertal induction, after 6-12 months of estrogen replacement therapy (ERT), after ≥ 36 months of ERT or ≥ 12 months after menarche. RESULTS The average age of TS patients at estrogen introduction and at the last control visit, when the uterus was considered mature, was 12.9 years and 16.1 years, respectively. The UV in patients with TS at the beginning of ERT was 1.55 ± 1.22 cm3 and was not significantly different from the UV in the prepubertal controls. The mature UV in patients with TS was 31.04 ± 11.78 cm3 and was significantly smaller than the UV of the postpubertal controls (45.68 ± 12.51 cm3, p<0.001). The FCR in girls with TS did not differ significantly from that in the prepubertal and postpubertal control groups, respectively. No prognostic factors could be established for the final UV. By the last control visit, thelarche had advanced in most patients to Tanner 4 and 5 (37.5% and 40%, respectively). CONCLUSIONS Before the onset of ERT, patients with TS have a uterus similar in size to that in prepubertal healthy girls. Pubertal induction in patients with TS causes a significant increase in the UV that is detectable after 6-12 months of ERT. The mature uterus is smaller in patients with TS than in the age-matched healthy population.
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Affiliation(s)
- Monika Obara-Moszynska
- Department of Paediatric Endocrinology and Rheumatology, Institute of Pediatrics, Poznan University of Medical Sciences, Poznan, Poland
- *Correspondence: Monika Obara-Moszynska,
| | - Lukasz Dzialach
- Student Scientific Society of Paediatric Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Barbara Rabska-Pietrzak
- Department of Paediatric Endocrinology and Rheumatology, Institute of Pediatrics, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Niedziela
- Department of Paediatric Endocrinology and Rheumatology, Institute of Pediatrics, Poznan University of Medical Sciences, Poznan, Poland
| | - Karina Kapczuk
- Department of Paediatric Endocrinology and Rheumatology, Institute of Pediatrics, Poznan University of Medical Sciences, Poznan, Poland
- Department of Gynaecology, Poznan University of Medical Sciences, Poznan, Poland
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Patel N, Davis S, Nahata L. TRANSITION-RELATED DISCUSSIONS AMONG ADOLESCENT FEMALES WITH TURNER SYNDROME: CURRENT PRACTICES AND ASSOCIATED FACTORS. Endocr Pract 2021; 27:56-62. [PMID: 33475502 DOI: 10.4158/ep-2020-0287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine the current transition practices and factors associated with the occurrence and timing of transition-related discussions among adolescents with Turner syndrome (TS). METHODS A retrospective chart review was conducted at a large pediatric academic center among females with TS seen between 12 and 25 years of age. Medical/developmental characteristics, the age at transition, documented transition-related discussions, and the utilization of transition readiness assessment tools were abstracted. Analyses were conducted to examine the age/occurrence of discussions and associated factors. RESULTS Records of 112 patients were reviewed. The average age of TS diagnosis was 7.6 ± 5.8 years, and the average age of those that transitioned from pediatric to adult care (n = 21) was 20.1 ± 2.0 years. Only 22% of individuals had documented discussions regarding transition to adult care, and no transition readiness tools were utilized. The majority of transition-related discussions began between 11 and 15 years. Estrogen and cardiovascular counseling were common (84% and 75%, respectively). Less than half of the subjects had reproductive (40%), lifestyle (43%), and psychosocial (12%) discussions. Cardiovascular conditions were associated with transition to adult care discussions, and neurodevelopmental conditions were associated with psychosocial counseling. In those that transitioned to adult care, transition-related discussions occurred in only half of patients. CONCLUSION Our findings emphasize the need for the development and implementation of a standardized transition process for adolescents with TS, with particular attention to transition to adult care and reproductive, lifestyle, and psychosocial counseling. The utilization of formal transition tools may also help prepare these girls for transition to adult care.
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Affiliation(s)
- Nisha Patel
- Division of Endocrinology, Nationwide Children's Hospital, Columbus, Ohio.
| | - Shanlee Davis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; eXtraOrdinary Kids Clinic, Children's Hospital Colorado, Aurora, Colorado
| | - Leena Nahata
- Division of Endocrinology, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; Center for Biobehavioral Health, Abigail Wexner Research Institute, Columbus, Ohio
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10
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Culen C, Herle M, Ertl D, Fröhlich‐Reiterer E, Blümel P, Wagner G, Häusler G. Less ready for adulthood?-Turner syndrome has an impact on transition readiness. Clin Endocrinol (Oxf) 2020; 93:449-455. [PMID: 33464630 PMCID: PMC7540424 DOI: 10.1111/cen.14293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Young women with Turner syndrome (TS) are known to be at risk for loss to medical follow-up. Recent literature indicates that there are disparities regarding transition readiness between different chronic conditions. So far, studies in young women with TS investigating their transition readiness compared to youths with other chronic conditions with no or minor neurocognitive challenges have not been reported. METHODS Patients (n = 52), 26 patients with Turner syndrome (mean age 17.24 ± 2.10) and 26 controls with type 1 diabetes or a rheumatic disease (mean age 17.41 ± 2.44), were recruited from specialized paediatric endocrine outpatient clinics. The Transition Readiness Assessment Questionnaire TRAQ-GV-15 was used to compare transition readiness scores between TS and controls. In addition, information on individual handling of the questionnaire was obtained. Descriptive statistics and nonparametric methods were used to analyse the data. RESULTS Significant differences for transition readiness scores were found between the two study groups. The global TRAQ-GV-15 score was significantly lower for females with TS. In particular, subscale 1 'autonomy' of the TRAQ-GV-15 showed lower scores in patients with TS. Patients with TS needed significantly more help and more time to complete the questionnaire. CONCLUSION Special attention should be given to young women with Turner syndrome in the preparation for the transitional phase. By incorporating the assessment of transition readiness specialists will find it easier to identify underdeveloped skills and knowledge gaps in their patients. Unless a multidisciplinary young adult clinic is established, an older age than 18 years at transfer to adult endocrine care might be beneficial.
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Affiliation(s)
- Caroline Culen
- Department of Pediatrics and Adolescent Medicine, Division of Paediatric Pulmology, Allergology and EndocrinologyMedical University of ViennaViennaAustria
| | - Marion Herle
- Department of Pediatrics and Adolescent Medicine, Division of Paediatric Pulmology, Allergology and EndocrinologyMedical University of ViennaViennaAustria
| | - Diana‐Alexandra Ertl
- Department of Pediatrics and Adolescent Medicine, Division of Paediatric Pulmology, Allergology and EndocrinologyMedical University of ViennaViennaAustria
- Vienna Bone and Growth CenterViennaAustria
| | | | - Peter Blümel
- Department of Paediatrics and Adolescent MedicineSozialmedizinisches Zentrum Süd ‐ Kaiser‐Franz‐Josef‐Spital mit Gottfried von Preyer'schem KinderspitalViennaAustria
| | - Gudrun Wagner
- Department for Child and Adolescent PsychiatryMedical University of ViennaViennaAustria
| | - Gabriele Häusler
- Department of Pediatrics and Adolescent Medicine, Division of Paediatric Pulmology, Allergology and EndocrinologyMedical University of ViennaViennaAustria
- Vienna Bone and Growth CenterViennaAustria
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11
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Mathez ALG, Monteagudo PT, do Nascimento Verreschi IT, Dias-da-Silva MR. Levonorgestrel correlates with less weight gain than other progestins during hormonal replacement therapy in Turner Syndrome patients. Sci Rep 2020; 10:8298. [PMID: 32427839 PMCID: PMC7237408 DOI: 10.1038/s41598-020-64992-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 04/22/2020] [Indexed: 01/15/2023] Open
Abstract
Turner Syndrome (TS) is associated with an increased risk of cardiovascular and metabolic complications. Furthermore, TS women need hormone replacement therapy (HRT), of which progestins can influence body weight. We aimed to analyze the metabolic and weight profile in a cohort of 111 TS women. They started receiving estrogen at 15.8 (±3.6) years old, with no change in hypertension, dysglycemia, and dyslipidemia incidence but with a tendency to increase overweight (p = 0.054). As the first used type of progestin, most had received cycles of 10 days per month of medroxyprogesterone (MPA) or levonorgestrel (LNG), then shifted to micronized progesterone (MP), which has currently become the most used one. By multiple linear regression analysis, we found that the prolonged use of MPA, LNG, or MP showed no metabolic change except for weight gain. The percentage of annual BMI increment was positive for all progestins used in TS women (MPA 2.2 ± 2.2; LNG 0.2 ± 1.2; and MP 2.2 ± 2.6 kg/m2), but LNG seemed to best prevent on weight gain over time (p < 0.05). In conclusion, metabolic comorbidities are prevalent in TS even before the HRT regimen, and LNG performed better on less weight gain than MPA and MP in our cohort of the TS population.
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Affiliation(s)
- Andréia Latanza Gomes Mathez
- Endocrinology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Patrícia Teófilo Monteagudo
- Endocrinology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
| | | | - Magnus Régios Dias-da-Silva
- Endocrinology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.,Laboratory of Molecular and Translational Endocrinology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
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12
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Morris LA, Tishelman AC, Kremen J, Ross RA. Depression in Turner Syndrome: A Systematic Review. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:769-786. [PMID: 31598804 PMCID: PMC7035188 DOI: 10.1007/s10508-019-01549-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/02/2019] [Accepted: 09/05/2019] [Indexed: 05/19/2023]
Abstract
Turner syndrome (TS) is a genetic condition characterized by partial or complete monosomy X. Alterations in hormonal function, height, and peer relationships, among other features and correlates of TS, appear to be risks for depressive illness. In order to summarize what is known about depression in Turner syndrome, with the aim of determining whether individuals with TS are at increased risk for depression, a literature search and analysis were conducted. In total, 69 studies were identified and 35 met criteria of being peer-reviewed English language articles that collected original data on the experience of depression in individuals with TS. Most studies used patient or parent questionnaires to evaluate depressive symptoms. These studies, a majority of which examined adults and half that examined adolescents, found that individuals with TS experienced more frequent and severe depressive symptoms than individuals without TS diagnoses. Articles studying children with TS did not demonstrate a difference in their depressive experience compared to individuals without TS. Three articles used clinician-administered scales, such as the Structured Clinical Interview for DSM-IV; all diagnosed depression in those with TS at higher rates than others. Five studies relied on expert opinion to evaluate depression. The remaining eight articles were case reports or case series that relied on expert opinion. From these data, we conclude that adolescents and adults with TS are at risk for depression and adulthood appears to be the period of the highest risk. Studies in the last 12 years show consistently more severe depressive symptoms in individuals with TS than in previous years. Implications, risk factors, and recommendations for future research are discussed.
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Affiliation(s)
- Lauren A Morris
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Massachusetts General Hospital/McLean Hospital Child and Adolescent Psychiatry Residency Program, 55 Fruit St. Yawkey 6A, Boston, MA, 02214, USA.
| | - Amy C Tishelman
- Department of Psychiatry, Harvard Medical School and Boston Children's Hospital, Boston, MA, USA
- Department of Endocrinology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jessica Kremen
- Department of Endocrinology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rachel A Ross
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Boston, MA, USA
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13
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Segerer SE, Segerer SG, Partsch CJ, Becker W, Nawroth F. Increased Insulin Concentrations During Growth Hormone Treatment in Girls With Turner Syndrome Are Ameliorated by Hormone Replacement Therapy. Front Endocrinol (Lausanne) 2020; 11:586055. [PMID: 33381083 PMCID: PMC7767985 DOI: 10.3389/fendo.2020.586055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/30/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Turner syndrome (TS) is characterized by complete or partial loss of one sex chromosome and is commonly associated with short stature, metabolic changes (such as central obesity, abnormal glucose tolerance and high triglycerides) and premature ovarian insufficiency (POI). Primary management of TS during childhood and adolescence comprises treatment with human growth hormone (hGH) and, in cases with early loss of ovarian function, hormone replacement therapy (HRT). Given that metabolic parameters are altered when HRT is applied during menopause, we analyzed whether metabolic changes might be positively or negatively affected within 10 years after HRT and/or hGH in girls with TS. DESIGN Observational study. METHODS Data were collected from the medical records of 31 girls with TS attending two endocrinologic centers in Germany between 2000 and 2020. Descriptive statistics are reported as the mean ± SEM or percentages. RESULTS The mean age at first presentation was 99.06 ± 8.07 months, the mean height was 115.8 ± 3.94 cm, and the mean BMI 19.0 ± 0.99 was kg/m2. Treatment with hGH was given to 96.8% of the girls, starting at an average age of 99.06 ± 8.70 months, and was continued for 67.53 ± 6.28 months. HRT was administered to 80.6% of all patients and was started at a mean age of 164.4 ± 4.54 months. During the follow-up, we did not observe any significant absolute changes in lipid parameters, but we detected beneficial effects of childhood hGH: significantly lower cholesterol (-0.206/month; p = 0.006), lower low density lipoprotein cholesterol (-0.216/month; p = 0.004), and higher high density lipoprotein cholesterol (+0.095/month; p = 0.048). Insulin concentrations, showed a significant increase attributable to hGH treatment (+0.206/month; p = 0.003), which was ameliorated by concomitant or subsequent HRT (-0.143/month; p = 0.039). CONCLUSION Treatment with hGH and HRT is provided to most girls with TS. Metabolic effects are associated with both modalities. Monitoring of metabolic changes appears to be important to detect unfavorable effects, and could guide treatment adjustment and duration.
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Affiliation(s)
- Sabine Elisabeth Segerer
- Department of Endocrinology, Centre for Infertility, Prenatal Medicine, Endocrinology and Osteology, Amedes Hamburg, Hamburg, Germany
- *Correspondence: Sabine Elisabeth Segerer,
| | | | | | - Wolfgang Becker
- Department of Laboratory Medicine, Medizinisches Versorgungszentrum (MVZ) MediVision Altona GmbH, Hamburg, Germany
| | - Frank Nawroth
- Department of Endocrinology, Centre for Infertility, Prenatal Medicine, Endocrinology and Osteology, Amedes Hamburg, Hamburg, Germany
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14
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Gravholt CH, Viuff MH, Brun S, Stochholm K, Andersen NH. Turner syndrome: mechanisms and management. Nat Rev Endocrinol 2019; 15:601-614. [PMID: 31213699 DOI: 10.1038/s41574-019-0224-4] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 12/12/2022]
Abstract
Turner syndrome is a rare condition in women that is associated with either complete or partial loss of one X chromosome, often in mosaic karyotypes. Turner syndrome is associated with short stature, delayed puberty, ovarian dysgenesis, hypergonadotropic hypogonadism, infertility, congenital malformations of the heart, endocrine disorders such as type 1 and type 2 diabetes mellitus, osteoporosis and autoimmune disorders. Morbidity and mortality are increased in women with Turner syndrome compared with the general population and the involvement of multiple organs through all stages of life necessitates a multidisciplinary approach to care. Despite an often conspicuous phenotype, the diagnostic delay can be substantial and the average age at diagnosis is around 15 years of age. However, numerous important clinical advances have been achieved, covering all specialty fields involved in the care of girls and women with Turner syndrome. Here, we present an updated Review of Turner syndrome, covering advances in genetic and genomic mechanisms of disease, associated disorders and multidisciplinary approaches to patient management, including growth hormone therapy and hormone replacement therapy.
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Affiliation(s)
- Claus H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Mette H Viuff
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Sara Brun
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Centre for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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15
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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: 20] [Impact Index Per Article: 4.0] [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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16
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Farquhar M, Jacobson M, Braun C, Wolfman W, Kelly C, Allen LM, Lega IC. Medical and gynecological comorbidities in adult women with Turner syndrome: our multidisciplinary clinic experience. Climacteric 2019; 23:32-37. [PMID: 31241369 DOI: 10.1080/13697137.2019.1627315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: Women with Turner syndrome (TS) are at increased risk for chronic health conditions. Reports describing the presence of comorbidities in older adult women with TS are limited. This study aimed to examine the prevalence of endocrine, gynecological, and other chronic medical conditions in a cohort of adult TS patients.Methods: A retrospective chart review was conducted on patients seen between 1 February 2015 and 1 July 2018 in a multidisciplinary TS clinic at a university-based ambulatory hospital in Toronto, Canada. All women seen at the TS clinic with a diagnosis of TS aged >18 years were included. The prevalence of diseases was determined overall and stratified by age (<40 and ≥40 years). Statistical comparisons were done using the chi-square test. The main study outcomes included the presence of comorbidities.Results: Of 122 adult women with TS, 24.5% had hypothyroidism, 16% had dysglycemia, and 27.9% had decreased bone mass. Hypothyroidism and dysglycemia were more common among older women (respectively age ≥40 years vs. age <40 years: 36.7% vs. 17.8%, p = 0.018; and 24.5% vs. 5.5%, p = 0.023). Gynecological conditions were identified in 35% of patients and were more common among older women (42.8% age ≥40 years vs. 13.7% age <40 years, p = 0.003). Overall, 41% had hearing impairment, 36.1% had cardiac abnormalities, 14.8% had hypertension, 18.8% had renal abnormalities, and 9% had celiac disease.Conclusions: The results of this study indicate a high prevalence of medical conditions in women with TS, especially those ≥40 years of age. Our study underscores the importance of multidisciplinary adult TS clinics for ongoing screening and management of comorbidities.
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Affiliation(s)
- M Farquhar
- Women's College Research Institute, Toronto, ON, Canada
| | - M Jacobson
- Department of Obstetrics and Gynecology, Women's College Hospital, Toronto, ON, Canada.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - C Braun
- Women's College Research Institute, Toronto, ON, Canada
| | - W Wolfman
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.,Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON, Canada
| | - C Kelly
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Endocrinology, Women's College Hospital, Toronto, ON
| | - L M Allen
- Department of Obstetrics and Gynecology, Women's College Hospital, Toronto, ON, Canada.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.,Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Gynecology, The Hospital for Sick Children, Toronto, ON, Canada
| | - I C Lega
- Women's College Research Institute, Toronto, ON, Canada.,Division of Endocrinology, Women's College Hospital, Toronto, ON
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17
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Laskay NMB, Estevez-Ordonez D, Atchley TJ, Amburgy JW, Harrigan MR. Report of Spontaneous Internal Carotid Dissection in a Patient with Turner Syndrome with a Systematic Review of the Literature. World Neurosurg 2019; 128:340-346. [PMID: 31096034 DOI: 10.1016/j.wneu.2019.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Spontaneous isolated carotid artery (CA) or vertebral artery (VA) dissection in the absence of coarctation has rarely been reported in the literature. We report the case of a 20-year-old woman with Turner syndrome (TS) who developed an acute left middle cerebral artery territory ischemic stroke from a spontaneous left internal carotid artery (ICA) dissection. We also conducted a systematic review of the literature to identify prior studies establishing an association or other case reports of isolated CA or VA dissection in TS. We queried 5 databases: MEDLINE (PubMed), Scopus, Embase, Cochrane Central, and CINAHL EBSCO. We used a standardized search clause across databases. Inclusion and exclusion criteria were applied to articles retrieved. Studies were excluded based on title alone, abstract, or after vetting the data presented in the paper. CASE DESCRIPTION Three case reports of patients with TS presenting with spontaneous intracranial and/or extracranial dissection of the ICA or VA were identified and included in this review. CONCLUSIONS We present a case of bilateral spontaneous dissection of the ICA in a patient with TS. Only 3 reported cases of spontaneous extra- or intracranial dissection of the CA or VA were identified via a systematic review of the literature. Arterial dissection of the CA or VA, especially in absence of aortic coarctation, in individuals affected with TS suggest the possibility of systemic vasculopathy. More research is needed to establish a better understanding of the phenotypic effects of TS in macro- and microvascular structures.
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Affiliation(s)
- Nicholas M B Laskay
- Department of Neurological Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Dagoberto Estevez-Ordonez
- Department of Neurological Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Travis J Atchley
- Department of Neurological Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John W Amburgy
- Department of Neurological Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mark R Harrigan
- Department of Neurological Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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18
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Krikščiūnienė R, Navickaitė I, Ereminienė E, Lukoševičius S, Žilaitienė B, Verkauskienė R. Relationship between Echocardiographic and Magnetic Resonance-Derived Measurements of the Thoracic Aorta in Turner Syndrome Patients. Int J Endocrinol 2019; 2019:9258726. [PMID: 31531017 PMCID: PMC6721444 DOI: 10.1155/2019/9258726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 07/16/2019] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Turner syndrome (TS) is assigned to the rare diseases group. Morbidity and mortality of TS patients are high, particularly due to the cardiovascular disorders, so monitoring for cardiovascular complications must be ensured. The data demonstrate a strong correlation between 2-dimensional echocardiographic (2Decho) evaluation and magnetic resonance imaging (MRI); still, according to recent guidelines, MRI remains a gold standard. In this study, we aimed to compare aortic dimensions on MRI and 2Decho in TS patients. METHODS 50 TS patients (≥18 years) were enrolled into the cross-sectional study. 2Decho and MRI were performed. The measurements of the aorta were assessed in five standard positions on 2Decho and in 9 standard positions on MRI; ASI (aortic size index) of the ascending aorta was calculated since reduced adult height is observed in TS patients. RESULTS ASI on echocardiography strongly correlated with ASI on MRI in all positions of the ascending aorta, but significantly larger medians of ASI were found on 2Decho in all positions of the ascending aorta and arch when compared with MRI measurements. Still, the prevalence of aortic sinus dilation was significantly and more frequently (52% vs. 38%, p < 0.001) observed on MRI when compared with 2Decho. CONCLUSION The relation of aortic size was significant in all positions when comparing the MRI and 2Decho methods; still, the dilatation of the sinus of aorta was more frequently found on MRI compared with echocardiography.
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Affiliation(s)
- Rūta Krikščiūnienė
- Lithuanian University of Health Sciences, Department of Endocrinology, Medical Academy, Kaunas, Lithuania
| | | | - Eglė Ereminienė
- Lithuanian University of Health Sciences, Department of Cardiology, Medical Academy, Kaunas, Lithuania
| | - Saulius Lukoševičius
- Lithuanian University of Health Sciences, Department of Radiology, Medical Academy, Kaunas, Lithuania
| | - Birutė Žilaitienė
- Lithuanian University of Health Sciences, Department of Endocrinology, Medical Academy, Kaunas, Lithuania
| | - Rasa Verkauskienė
- Lithuanian University of Health Sciences, Department of Endocrinology, Medical Academy, Kaunas, Lithuania
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19
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Kriksciuniene R, Zilaitiene B, Lukosevicius S, Ereminiene E, Klimaite R, Verkauskiene R. The main predictors of the enlargement of ascending aorta in Turner syndrome: a cross-sectional contrast-enhanced magnetic resonance angiography study. MINERVA ENDOCRINOL 2018; 44:185-191. [PMID: 30290692 DOI: 10.23736/s0391-1977.18.02818-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The aim of this study was to identify the main predictors of the enlargement of ascending aorta and to assess the possible relation between reduced bone mineral density and a diameter of ascending aorta in the specific Turner syndrome (TS) population. METHODS Fifty adult females diagnosed with TS have been enrolled into the cross-sectional study. Dimensions of ascending aorta have been measured in four positions using thoracic magnetic resonance imaging, Aortic Size Index (ASI) has been calculated. BMD has been assessed on dual-energy-X ray absorptiometry (DXA) in 1-4 lumbar vertebrae and neck of the femur. According to Z Score on DXA two groups have been formed: a group of patients with normal BMD and a group with reduced BMD. Metabolic parameters and the measurements of ascending aorta have been compared between the two groups. RESULTS Extremely high rate of the dilatation of the root of aorta (up to 50%) was identified in this study. The larger ASI has been found in patients with reduced BMD, negative relation between BMD and ASI has been identified, although after the adjustment for SHRT this correlation remained insignificant. In the multivariate analysis, the main factors affecting ASI were age, body surface area and bicuspid aortic valve. CONCLUSIONS The main factors associated with the enlargement of ascending aorta in Turner syndrome were age, body surface area and bicuspid aortic valve, the relation between diameter of ascending aorta and bone mineral density was not identified.
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Affiliation(s)
- Ruta Kriksciuniene
- Department of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania - .,Kauno Klinikos, Department of Endocrinology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania -
| | - Birute Zilaitiene
- Department of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Kauno Klinikos, Department of Endocrinology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Saulius Lukosevicius
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Egle Ereminiene
- Department of Cardiology, Medical Academy, Lithuanian University Of Health Sciences, Kaunas, Lithuania
| | - Raimonda Klimaite
- Department of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Kauno Klinikos, Department of Endocrinology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rasa Verkauskiene
- Department of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Kauno Klinikos, Department of Endocrinology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
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Hamza RT, Mira MF, Hamed AI, Ezzat T, Sallam MT. Anti-Müllerian hormone levels in patients with turner syndrome: Relation to karyotype, spontaneous puberty, and replacement therapy. Am J Med Genet A 2018; 176:1929-1934. [PMID: 30088853 DOI: 10.1002/ajmg.a.40473] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/12/2017] [Accepted: 06/21/2018] [Indexed: 11/10/2022]
Abstract
Most girls with Turner syndrome (TS) suffer from incomplete sexual development, premature ovarian failure, and infertility due to abnormal ovarian folliculogenesis. Serum anti-Müllerian hormone (AMH) levels reflect the ovarian reserve in females, even in childhood. Thus, we aimed to assess serum AMH levels in girls with TS and its relation to karyotype, spontaneous puberty, and growth hormone (GH) therapy. Fifty TS were compared to 50 age- and sex-matched controls. All subjects were subjected to history, anthropometric assessment, Tanner pubertal staging and measurement of serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and AMH. Karyotype results were obtained from patients' records. Serum AMH was measurable in 12 TS patients (24%). The lowest frequency of measurable AMH was in patients with a karyotype of 45,X. The measurable AMH was associated with spontaneous breast development (p = .003) and spontaneous menarche (p = .001). AMH correlated negatively with FSH (r = -.846, p = .000) and LH (r = -.83, p = .034). GH therapy increased the odds of having measurable AMH in TS girls (p = .002). In conclusion, AMH was associated with karyotype, spontaneous pubertal development, LH, and FSH in TS girls and may serve as a useful marker of ovarian function and ongoing follicular development in prepuberty.
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Affiliation(s)
- Rasha T Hamza
- Departments of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Marwa F Mira
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amira I Hamed
- Departments of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Treiz Ezzat
- Departments of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud T Sallam
- Department of Clinical and Chemical Pathology, National Research Center, Cairo, Egypt
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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: 7] [Impact Index Per Article: 1.2] [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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Ibarra-Gasparini D, Altieri P, Scarano E, Perri A, Morselli-Labate AM, Pagotto U, Mazzanti L, Pasquali R, Gambineri A. New insights on diabetes in Turner syndrome: results from an observational study in adulthood. Endocrine 2018; 59:651-660. [PMID: 28593616 DOI: 10.1007/s12020-017-1336-z] [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: 01/10/2017] [Accepted: 05/29/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To explore the characteristics of diabetes mellitus in adults with Turner syndrome. DESIGN Observational study consisting of a prospective phase after the access of adults with Turner syndrome to the Endocrinology Unit (median period of follow-up 15.6, interquartile range: 12.0-24.5 months) and a retrospective collection of data from the diagnosis of Turner syndrome until the time of access to the Endocrinology Unit. A total of 113 Italian Turner syndrome patients were included in the study. During the prospective phase of the study, each patient underwent physical examination, fasting blood sampling, and an oral glucose tolerance test on a yearly basis. Oral glucose tolerance test was used to perform the diagnosis of diabetes mellitus. RESULTS Before access to the Endocrinology Unit, diabetes mellitus was diagnosed in two Turner syndrome patients. Another five cases of diabetes mellitus were diagnosed at the first access to the Endocrinology Unit, whereas seven new cases of diabetes mellitus were diagnosed during the prospective phase of the study. At the diagnosis of diabetes mellitus, only one patient had fasting glucose above 126 mg/dL, and only two had an HbA1c value >6.5% (48 mmol/mol). When compared to normo-glucose tolerant patients, the diabetic patients had a significantly lower insulin-to-glucose ratio at 30 and 60 min of the oral glucose tolerance test. In the regression analyses, only age was associated with the development of diabetes mellitus. CONCLUSIONS This study confirms that diabetes mellitus is frequent in Turner syndrome and suggests that it is specific to the syndrome. In addition, this study demonstrates that oral glucose tolerance test is a more sensitive test than HbA1c for the diagnosis of diabetes mellitus in Turner syndrome.
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Affiliation(s)
- Daniela Ibarra-Gasparini
- Division of Endocrinology, Department of Medical & Surgical Sciences, University Alma Mater Studiorum, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Paola Altieri
- Division of Endocrinology, Department of Medical & Surgical Sciences, University Alma Mater Studiorum, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Emanuela Scarano
- Pediatric Endocrinology and Rare Disease Unit, Department of Medical & Surgical Sciences, University Alma Mater Studiorum, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Annamaria Perri
- Pediatric Endocrinology and Rare Disease Unit, Department of Medical & Surgical Sciences, University Alma Mater Studiorum, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Antonio M Morselli-Labate
- Division of Endocrinology, Department of Medical & Surgical Sciences, University Alma Mater Studiorum, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Uberto Pagotto
- Division of Endocrinology, Department of Medical & Surgical Sciences, University Alma Mater Studiorum, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Laura Mazzanti
- Pediatric Endocrinology and Rare Disease Unit, Department of Medical & Surgical Sciences, University Alma Mater Studiorum, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Renato Pasquali
- Division of Endocrinology, Department of Medical & Surgical Sciences, University Alma Mater Studiorum, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Alessandra Gambineri
- Division of Endocrinology, Department of Medical & Surgical Sciences, University Alma Mater Studiorum, S. Orsola-Malpighi Hospital, Bologna, Italy.
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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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Gawlik AM, Hankus M, Szeliga K, Antosz A, Gawlik T, Soltysik K, Drosdzol-Cop A, Wilk K, Kudela G, Koszutski T, Malecka-Tendera E. Late-Onset Puberty Induction by Transdermal Estrogen in Turner Syndrome Girls-A Longitudinal Study. Front Endocrinol (Lausanne) 2018; 9:23. [PMID: 29472893 PMCID: PMC5810248 DOI: 10.3389/fendo.2018.00023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/18/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Estrogen replacement therapy (ERT) for Turner syndrome (TS) is a widely discussed topic; however, the optimal model of ERT for patients with delayed diagnosis and/or initiation of therapy is still unclear, mainly due to insufficient data. We present the results of a prospective observational single-center study in which the efficacy of late-onset puberty induction by one-regimen transdermal ERT in TS girls was evaluated. METHODS The analysis encompassed 49 TS girls (63.3% with 45,X) with hypergonadotropic hypogonadism in whom unified transdermal ERT protocol was used for puberty induction (first two months 12.5 μg/24 h, thereafter 25.0 μg/24 h until breakthrough bleeding). Clinical visits for examination and therapy modification took place every 3-6 months. Transabdominal pelvic ultrasound examinations were performed at least twice: at the beginning and at the end of follow-up. RESULTS The mean (SD) age at ERT induction was 15.1 (1.3) years. The duration of follow-up was 2.4 (1.1) years. Half of all the patients had at least B2 after 0.57 years, B3 after 1.1 years, B4 after 1.97 years, and menarche after 1.82 years from ERT initiation. With earlier initiation of ERT (≤14 years), B2 (p = 0.059) was achieved faster and B4 (p = 0.018) significantly slower than with the later start of ERT. Thirty-four (94.4%) patients had at least stage B3 at menarche. The karyotype, initial weight, and body mass index had no impact on puberty tempo during ERT. The uterine volume increased significantly during ERT in all the study group (p < 0.0001), and in half of the patients, the increase was at least 12.4-fold. It did not correlate with the duration of treatment (p = 0.84) or the dose of estradiol per kilogram (p = 0.78), nor did it depend on karyotype (p = 0.71) or age at ERT initiation (p = 0.28). There were no differences in ΔhSDS during ERT (p = 0.63) between the two age groups (ERT ≤14 and >14 years). CONCLUSION The presented easy-to-use fixed-dose regimen for late-onset puberty induction allowed for a satisfactory rate of achieving subsequent puberty stages and did not influence the growth potential.
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Affiliation(s)
- Aneta Monika Gawlik
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Magdalena Hankus
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Kamila Szeliga
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Aleksandra Antosz
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Tomasz Gawlik
- Nuclear Medicine and Endocrine Oncology Department, Maria Skłodowska-Curie Memorial Institute and Cancer Center, Gliwice Branch, Gliwice, Poland
| | - Kamil Soltysik
- Department of Anatomy and Molecular Cell Biology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Krzysztof Wilk
- Department of Obstetrics and Gynecology, The Boni Fratres Catoviensis, Katowice, Poland
| | - Grzegorz Kudela
- Department of Pediatric Surgery and Urology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Tomasz Koszutski
- Department of Pediatric Surgery and Urology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Ewa Malecka-Tendera
- Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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26
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Sakakibara H. Transition of Women with Turner Syndrome from Pediatrics to Adult Health Care: Current Situation and Associated Problems. Front Pediatr 2017; 5:28. [PMID: 28261575 PMCID: PMC5313480 DOI: 10.3389/fped.2017.00028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 02/01/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hideya Sakakibara
- Department of Gynecology, Yokohama City University, Medical Center , Yokohama , Japan
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27
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Hokken-Koelega A, van der Lely AJ, Hauffa B, Häusler G, Johannsson G, Maghnie M, Argente J, DeSchepper J, Gleeson H, Gregory JW, Höybye C, Keleştimur F, Luger A, Müller HL, Neggers S, Popovic-Brkic V, Porcu E, Sävendahl L, Shalet S, Spiliotis B, Tauber M. Bridging the gap: metabolic and endocrine care of patients during transition. Endocr Connect 2016; 5:R44-R54. [PMID: 27803155 PMCID: PMC5118971 DOI: 10.1530/ec-16-0028] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/01/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Seamless transition of endocrine patients from the paediatric to adult setting is still suboptimal, especially in patients with complex disorders, i.e., small for gestational age, Turner or Prader-Willi syndromes; Childhood Cancer Survivors, and those with childhood-onset growth hormone deficiency. METHODS An expert panel meeting comprised of European paediatric and adult endocrinologists was convened to explore the current gaps in managing the healthcare of patients with endocrine diseases during transition from paediatric to adult care settings. RESULTS While a consensus was reached that a team approach is best, discussions revealed that a 'one size fits all' model for transition is largely unsuccessful in these patients. They need more tailored care during adolescence to prevent complications like failure to achieve target adult height, reduced bone mineral density, morbid obesity, metabolic perturbations (obesity and body composition), inappropriate/inadequate puberty, compromised fertility, diminished quality of life and failure to adapt to the demands of adult life. Sometimes it is difficult for young people to detach emotionally from their paediatric endocrinologist and/or the abrupt change from an environment of parental responsibility to one of autonomy. Discussions about impending transition and healthcare autonomy should begin in early adolescence and continue throughout young adulthood to ensure seamless continuum of care and optimal treatment outcomes. CONCLUSIONS Even amongst a group of healthcare professionals with a great interest in improving transition services for patients with endocrine diseases, there is still much work to be done to improve the quality of healthcare for transition patients.
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Affiliation(s)
| | | | | | - Gabriele Häusler
- Medical University and General Hospital of ViennaVienna, Austria
| | | | - Mohamad Maghnie
- Istituto Giannina GasliniUniversity of Genova, Genova, Italy
| | - Jesús Argente
- Hospital Infantil Universitario Niño JesúsMadrid, Spain
| | | | | | | | - Charlotte Höybye
- Department of Molecular Medicine and SurgeryKarolinska Institute and Department of Endocrinology, Metabolism and Diabetology, Karolinska University Hospital, Stockholm, Sweden
| | - Fahrettin Keleştimur
- Department of EndocrinologySchool of Medicine, Erciyes University, Kayseri, Turkey
| | - Anton Luger
- Sahlgrenska University HospitalGöteborg, Sweden
| | - Hermann L Müller
- Department of PediatricsKlinikum Oldenburg, Medical Campus University Oldenburg, Oldenburg, Germany
| | | | | | | | - Lars Sävendahl
- Department of Women's and Children's HealthKarolinska Institutet, and Pediatric Endocrinology Unit, Karolinska University Hospital, Stockholm, Sweden
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28
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Turner syndrome: From birth to adulthood. ACTA ACUST UNITED AC 2015; 62:499-506. [PMID: 26298398 DOI: 10.1016/j.endonu.2015.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/13/2015] [Accepted: 06/16/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Turner syndrome is characterized by a great variability of clinical manifestations caused by a total or partial loss of X-chromosome. PATIENTS AND METHODS A retrospective, descriptive study of the diagnosis, course, and current status of patients with Turner syndrome followed up at our section over the past 40 years, based on review of medical records supplemented with a telephone survey. RESULTS Forty-five female patients with a current mean age of 22.95years (range 2-38) and a mean age at diagnosis of 4.71 were included. Sixty-three percent of them showed a mosaic karyotype. Short stature was the most common reason for consultation (54%), with increased prenatal diagnosis in most recent cases. Seventy-two percent have been treated with growth hormone, together with oxandrolone in 26%. Final stature was short in 69% of patients. Gonadal failure was found in 66%; most of whom received replacement therapy. Three patients achieved pregnancy by oocyte donation. The 31 adult patients are mainly monitored by the endocrinology (37.5%) and/or gynecology (34.4%) departments. As regards psychosocial aspects, 22% required support during school, and 80% completed middle to high level education. Two patients died, one due to dissecting aortic aneurysm and the other one, who had multiple pathological conditions, from respiratory failure. CONCLUSIONS Short stature is the main cause of diagnosis in patients with Turner syndrome; most cases show genetic mosaicism. The most common clinical manifestations include short stature and gonadal failure. Eighty percent of patients complete middle or high education. In adulthood, follow-up is irregular, sometimes scarce, and clearly improvable.
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Kapellen TM, Kiess W. Transition of adolescents and young adults with endocrine diseases to adult health care. Best Pract Res Clin Endocrinol Metab 2015; 29:505-13. [PMID: 26051306 DOI: 10.1016/j.beem.2015.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The transition of adolescents with chronic endocrine diseases to adult care remains a major challenge for all those participating in the process. In paediatric endocrinology, a variety of diseases pose different challenges in the transitional process. The outcome of this transitional process is often judged by what happens after transfer. The young patient needs to be educated early on about continuing treatment into adulthood, resulting in full autonomy over their health care in early adulthood. Therefore, to optimize transition, paediatric and adult endocrinologists must work together to achieve continuity and to meet the needs of young patients.
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Affiliation(s)
- Thomas M Kapellen
- Hospital for Children and Adolescents, University of Leipzig, Germany.
| | - Wieland Kiess
- Hospital for Children and Adolescents, University of Leipzig, Germany
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30
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Polyzos NP, Sakkas E, Vaiarelli A, Poppe K, Camus M, Tournaye H. Thyroid autoimmunity, hypothyroidism and ovarian reserve: a cross-sectional study of 5000 women based on age-specific AMH values. Hum Reprod 2015; 30:1690-6. [DOI: 10.1093/humrep/dev089] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 03/19/2015] [Indexed: 11/13/2022] Open
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