Novel insights in Turner syndrome

PURPOSE OF REVIEW

Turner syndrome is the most common sex chromosome abnormality in female individuals, affecting 1/2000-1/2500 female newborns. Despite the high incidence of this condition, the mechanisms underlying the development of multiorgan dysfunction have not been elucidated.

RECENT FINDINGS

Clinical features involve multiple organ systems and include short stature, dysmorphic facial features, delayed puberty and gonadal failure, cardiac and renal abnormalities, audiologic abnormalities, and a high prevalence of endocrine and autoimmune disorders. Paucity of available genotype/phenotype correlation limits the ability of clinicians to provide accurate guidance and management. Given the advent of robust genetic testing and analysis platforms, developments in the genetic basis of disease are materializing at a rapid pace.

SUMMARY

The objective of this review is to highlight the recent advances in knowledge and to provide a framework with which to apply new data to the foundational understanding of the condition.

Renal morphology and function from childhood to adulthood in Turner syndrome

BACKGROUND

Turner syndrome (TS) is a chromosomal disorder with various complications, including congenital anomaly of the kidney and urinary tract (CAKUT). However, its renal function remains poorly known. Therefore, this study aimed to evaluate renal function in TS of various ages from childhood to adulthood.

METHODS

We retrospectively analyzed 63 patients with TS who visited our hospital between 1989 and 2020, examined their renal morphology, and analyzed renal function by calculating the estimated glomerular filtration rate (eGFR) using formulas applicable for Japanese populations.

RESULTS

Renal morphological abnormality was observed in 22 cases (35.0%) (horseshoe kidney, 7 [11.1%]; hydronephrosis, 11 [17.5%]; duplex collecting system, 3 [4.8%]; and single unilateral kidney, 1 [1.6%]). We evaluated the eGFR of 47 subjects aged 2.8-39.3 years and classified them into Group 1 (with CAKUT, n = 15) and Group 2 (without CAKUT, n = 32). The eGFR at the first visit and the final follow-up was not statistically different between these groups. In Group 1 with CAKUT, the eGFR was not significantly different between that at the first visit and that at the final follow-up (p = 0.21). During the observation period (median, 7.9 years), the eGFR of all individuals in both groups gradually decreased with age, but did not fall < 60 mL/min/1.73 m², which defines chronic kidney disease (CKD).

CONCLUSIONS

The renal function of TS remained normal in all cases during our investigation period, and no one developed CKD by the age of 40 years.

Labial synechiae in geriatric patients with turner syndrome: A case report

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Turner Syndrome is a chromosomal condition that affects development in females, occurring in approximately 1/2500 live female births.

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Labial Synechiae usually noted in female with numerous UTIs and vaginal infections.

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Synechiae is probably the result of multiple recurrent infections that could cause a chronic inflammation, denudating epithelial cells forming an agglutination of both labia.

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There is no literature to suggest any link between TS and LS directly.

Introduction

Turner syndrome (TS) is a chromosomal condition that affects development in females, resulted from a complete or partial absence of the second X chromosome or from structural anomalies (mosaicism) of one X chromosome. TS is one of the most common sex chromosome disorders among live-born female births.

Case presentation

We presented with a 63 y.o. Female, who admitted to our Hospital with a chief complaint of pain when urinating and frequent haematuria. She has a history of Turner Syndrome (45 XO). Local examination in the lithotomy position revealed labial agglutination involving the labia majora. We did a Cystoscopy to evaluate the bladder and urethra, and then biopsied the tissues. Vaginal Reconstruction was performed to repair the Labial Synechiae. The biopsy showed that this histological finding is consistent with Follicular Cystitis that could cause by chronic UTIs.

Discussion

Labial Synechiae (LS), or Labial agglutination is a disorder of the female genitalia characterized by thin, membranous adherence of the labia. LS usually noted in female with numerous UTIs and vaginal infections. Goel et al confirmed that LS is not a congenital disorder. In a retrospective study, they found out that LS is probably caused by multiple numerous UTIs that may cause a membrane to formed around the labia. The negligence and chronicity of this condition may have thickened the synechiae, making it persist for a long time, and can actually cause a symptom to appear.

Conclusion

There is no literature to suggest any link between TS and LS directly.