Deficient knowledge in adult Turner syndrome care as an incentive to found Turner centers in Germany

Abstract

Objective: Turner syndrome (TS) is characterized by the complete or partial loss of the second sex chromosome and associated with a wide range of clinical manifestations. We aimed to assess the medical care of adult patients with TS in Germany.

Design: Retrospective multicenter observational study.

Methods: Data were collected from medical records of 258 women with TS treated between 2001 and 2017 in five non-university endocrinologic centers in Germany.

Results: Mean age was 29.8 ± 11.6 years, mean height 152 ± 7.7 cm, and mean BMI 26.6 ± 6.3 kg/m2. The karyotype was known in 50% of patients. Information on cholesterol state, liver enzymes, and thyroid status was available in 81-98% of women with TS; autoimmune thyroiditis was diagnosed in 37%. Echocardiography was performed in 42% and cardiac MRI in 8.5%, resulting in a diagnosis of cardiovascular disorder in 28%. Data on growth hormone therapy were available for 40 patients (15%) and data concerning menarche in 157 patients (61%).

Conclusion: In 258 women with TS, retrospective analysis of healthcare data indicated that medical management was focused on endocrine manifestations. Further significant clinical features including cardiovascular disease, renal malformation, liver involvement, autoimmune diseases, hearing loss, and osteoporosis were only marginally if at all considered. Based on this evaluation and in accordance with recent guidelines, we compiled a documentation form facilitating the transition from pediatric to adult care and further medical management of TS patients. The foundation of Turner Centers in March 2019 will improve the treatment of TS women in Germany.

Keywords: Turner centers; Turner syndrome; adult height; cardiovascular involvement; medical care.

Figure 1

Distribution of karyotypes in patients with TS (documented in medical records).

Figure 2

Distribution of low-density lipoprotein (LDL) depending on serum values of liver function. Groups were categorized by: normal liver values (GPT (glutamate pyruvate transaminase)/GOT (glutamate oxaloacetate transaminase) <35 U/I, Gamma-GT <40 U/I), increased liver enzymes (GPT/GOT >35 U/I) and increased Gamma-GT (>40 U/I) (mean ± s.d., n = 213).

Figure 3

Distribution and comparison of age depending on serum levels of liver function. Groups were categorized by normal liver values (GPT (glutamate pyruvate transaminase)/GOT (glutamate oxaloacetate transaminase) <35 U/I and Gamma-GT <40 U/I), increased liver enzymes (GPT/GOT >35 U/I) and increased Gamma-GT (>40 U/I) (mean ± s.d., n = 213).