Clinical Endocrinology

An evaluation of early cardiometabolic risk factors in children and adolescents with Turner syndrome

Authors

  • Clodagh S. O'Gorman,

    Corresponding author
    1. Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
    2. Physiology and Experimental Medicine Program, The Hospital for Sick Children Research Institute, University of Toronto, Toronto, ON, Canada
    Current affiliation:
    1. Department of Paediatrics, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
    • Divisions of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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  • Catriona Syme,

    1. Physiology and Experimental Medicine Program, The Hospital for Sick Children Research Institute, University of Toronto, Toronto, ON, Canada
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  • Jun Lang,

    1. Divisions of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
    2. Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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  • Timothy J. Bradley,

    1. Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
    2. Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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  • Greg D. Wells,

    1. Anesthesia, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
    2. Physiology and Experimental Medicine Program, The Hospital for Sick Children Research Institute, University of Toronto, Toronto, ON, Canada
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  • Jill K. Hamilton

    1. Divisions of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
    2. Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
    3. Physiology and Experimental Medicine Program, The Hospital for Sick Children Research Institute, University of Toronto, Toronto, ON, Canada
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Correspondence: Clodagh O'Gorman, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.E-mail: clodagh.ogorman@ul.ie

Summary

Background and Objectives

Turner syndrome (TS) confers increased lifetime risk of type 2 diabetes mellitus and cardiovascular disease. We compared cardiometabolic risk factors and measures of subcutaneous, visceral adipose tissue and intra-myocellular lipid between young TS girls and an age- and BMI-standard deviation scores (SDS)-matched healthy female cohort.

Patients and Methods

A cross-sectional cohort study was conducted at the Hospital for Sick Children, Toronto. Nineteen TS and 17 control girls (13·7 ± 2·5 vs 12·7 ± 3·4 years of age, respectively, P = 0·30). Multiple-sample oral glucose tolerance test with measurement of fasting insulin, LDL, HDL, triglycerides, adiponectin and highly sensitive C-reactive protein (hsCRP) was performed. Subcutaneous adipose tissue, visceral adipose tissue intramyocellular lipid levels evaluated by magnetic resonance techniques. Insulin secretion (IS), sensitivity (Si) and the insulin secretion–sensitivity index (ISSI-2) were calculated from oral glucose tolerance test data.

Results

Five TS and no controls had impaired fasting glucose or impaired glucose tolerance; none had type 2 diabetes mellitus. Insulin sensitivity and insulin secretion were similar between groups; ISSI-2 was lower in TS (923·5 ± 307·3 vs 659·1 ± 387·3; P = 0·03). TS girls had higher blood pressure (82·5 ± 13·6 vs 73·5 ± 5·5 mmHg; P = 0·0146), waist circumference (76·0 ±11·8 vs 65·9 ± 9·7; P = 0·0087) and subcutaneous adipose tissue (135·6 ± 88·6 vs 69·3 ± 59·9; P = 0·01) than controls. Visceral adipose tissue, intramyocellular lipid levels and adiponectin were not different between groups. TS girls also had higher triglycerides (1·1 ± 0·6 vs 0·7 ± 0·3; P = 0·003), total cholesterol (4·4 ± 0·7 vs 3·9 ± 0·4; P = 0·02) and hsCRP (2·0 ± 1·9 vs 0·8 ± 0·3; P = 0·01).

Conclusions

TS girls exhibit more cardiometabolic risk factors and reduced beta cell function compared with age- and BMI-SDS-matched girls. Increased awareness of early risk of type 2 diabetes mellitus and hypertension in TS girls is needed.

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