The Cutoff of Gonadotropins for Close Evaluation of Cardiometabolic Risk Factors in Turner Syndrome

Shahin Koohmanaee, Behrang Motamed, Sharareh Ghorbandoust, Hamidreza Badeli, Afagh Hassanzadeh Rad, Setila Dalili, Zohre Darabipour

Abstract


Background: Turner syndrome is a common genetic disorder in females. It is a disorder characterized by variable number of clinical features, so it needs a multidisciplinary approach for care. Therefore, we aimed to define the cutoff of gonadotropins for close evaluation of cardiometabolic risk factors in Turner syndrome. Methods: This is a case‑control study on 31 patients with Turner syndrome and 31 healthy individuals. Clinical examination including blood pressure measurement and systems evaluation was performed. Laboratory testing, which included 12‑h fasting, assessed lipid profile, glucose, and serum gonadotropin. Results: Turner syndrome had a higher BMI, systolic, and diastolic blood pressure than the normal group (P < 0.001) Patients with Turner syndrome had significantly higher total cholesterol, low‑density lipoprotein, triglyceride, and TG‑to‑high‑density lipoprotein ratio compared to the healthy individuals (P < 0.05). With increasing LH and FSH, BMI values, systolic blood pressure, and total cholesterol increased significantly (P < 0.001). Serum TG levels in Turner syndrome were only positively correlated with LH and not correlated with FSH. The cutoff point of LH and FSH for triglyceride in upper 75 percentile were 31 (sensitivity = 38.1%, specificity = 80%) and 48 (sensitivity = 61.9%, specificity = 70%), respectively. Conclusions: Based on dyslipidemia and lower level of ejection fraction, considering cardiometabolic risk factors in lower age groups in Turner syndrome can be recommended.

Keywords


Child; gonadotropins; Turner syndrome

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References


Hall JG, Gilchrist DM. Turner syndrome and its variants. Pediatr

Clin North Am 1990;37:1421‑40.

Gravholt CH, Andersen NH, Conway GS, Dekkers OM,

Geffner ME, Klein KO, et al. Clinical practice guidelines for the

care of girls and women with turner syndrome: Proceedings from

the 2016 Cincinnati international turner syndrome meeting. Eur J

Endocrinol 2017;177:G1‑G70.

Gravholt CH, Viuff MH, Brun S, Stochholm K, Andersen NH.

Turner syndrome: mechanisms and management. Nat Rev

Endocrinol 2019;15:601‑14.

Davis SM, Geffner ME. Cardiometabolic health in Turner

syndrome. American Journal of Medical Genetics 2019:181;6066.

Brun S, Cleemann L, Holm K, Salskov G, Erlandsen M,

Berglund A, et al. Five‑year randomized study demonstrates

blood pressure increases in young women with Turner syndrome

regardless of estradiol dose. Hypertension 2019;73:242‑8.

Lebenthal Y, Levy S, Sofrin‑Drucker E, Nagelberg N,

Weintrob N, Shalitin S, et al. The natural history of metabolic

comorbidities in turner syndrome from childhood to early

adulthood: Comparison between 45, X monosomy and other

karyotypes. Front Endocrinol 2018;9:27.

Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J,

Hill MN, et al. Subcommittee of professional and public

education of the American heart association council on high

blood pressure research. Recommendations for blood pressure

measurement in humans and experimental animals: Part 1: Blood

pressure measurement in humans: A statement for professionals

from the subcommittee of professional and public education of

the American heart association council on high blood pressure

research. Hypertension 2005;45:142‑161.

Gupte AA, Pownall HJ, Hamilton DJ. Estrogen: An emerging

regulator of insulin action and mitochondrial function. J Diabetes

Res 2015;2015:916585.

Mauvais‑Jarvis F. Menopause, estrogens, and glucose

homeostasis in women. Adv Exp Med Biol 2017;1043:217‑25.

O’Gorman CS, Syme C, Lang J, Bradley TJ, Wells GD,

Hamilton JK. An evaluation of early cardiometabolic risk

factors in children and adolescents with Turner syndrome. Clin

Endocrinol (Oxf) 2013;78:907‑13.

Hanew K, Tanaka T, Horikawa R, Hasegawa T, Fujita K,

Yokoya S. Women with Turner syndrome are at high risk

of lifestyle‑related disease ‑From questionnaire surveys

by the Foundation for growth science in Japan. Endocr J

;63:449‑56.

Álvarez‑Nava F, Racines M, Witt J, Guarderas J,

Estévez M, Lanes R. Anthropometric variables as cardiovascular

risk predictors in a cohort of adult subjects with Turner

syndrome. Diabetes Metab Syndr Obes 2019;12:1795‑809.

Los E, Quezada E, Chen Z, Lapidus J, Silberbach M. Pilot study

of blood pressure in girls with Turner syndrome: An awareness

gap, clinical associations, and new hypotheses. Hypertension

;68:133‑6.

Elsheikh M, Conway GS. The impact of obesity on cardiovascular

risk factors in Turner’s syndrome. Clin Endocrinol (Oxf)

;49:447‑50.

Pirgon Ö, Atabek ME, Oran B, Güçlü R. Atherogenic lipid

profile and systolic blood pressure are associated with carotid

artery intima‑media thickness in children with Turner syndrome.

J Clin Res Pediatr Endocrinol 2008;1:62‑71.

Elsheikh M, Bird R, Casadei B, Conway G, Wass J. The effect of

hormone replacement therapy on cardiovascular hemodynamics

in women with Turner’s syndrome. J Clin Endocrinol Metab

;85:614‑8.

Irzyniec TJ, Jeż W. The influence of hormonal replacement and

growth hormone treatment on the lipids in Turner syndrome.

Gynecol Endocrinol 2014;30:250‑3.