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Fibroscan: a new noninvasive method for evaluation of liver dysfunction in Turner syndrome


  • Part of the data of this study was presented as oral communication at the 8th Joint Meeting of the LWPES/ESPE, September 9–12, 2009, New York, USA.

Maria Francesca Messina, MD, Dipartimento di Scienze Pediatriche, Policlinico Universitario, Pad. NI, III piano, Via Consolare Valeria 1, 98124 Messina, Italy. Tel.: + 39 090 221 3947; fax: + 39 090 221 2143; e-mail:


Eur J Clin Invest 2011; 41 (2): 183–188


Background  Raised liver enzyme value is frequently detected in patients with Turner syndrome (TS), but its clinical importance is still unclear.

Objective  To investigate the entity of liver involvement in TS and to avoid the invasiveness of liver biopsy, we planned to measure liver stiffness by transient elastography (TE).

Design  Cross-sectional study.

Patients and methods  Twenty-five consecutive patients with TS and a chronological age ≥ 12·5 years (mean age = 21·7 years), full pubertal development and final height’s achievement were enrolled and investigated by blood biochemical analyses [glucose, insulin, aspartate-aminotransferase (AST), alanine-aminotransferase (ALT), gamma-glutamil transferase (GGT), alkaline phosphatase, cholesterol, triglyceride, HDL-cholesterol], ultrasonography and TE of the liver.

Results  Of 25, 7 subjects (28%) showed liver enzyme levels higher than the normal upper limit. Mean liver stiffness value in the entire study group was 4·5 ± 1·7 kPa, being significantly higher in patients with abnormal liver enzymes than in those with normal liver biochemistry (6·0 ± 2·9 vs. 4·0 ± 0·9, P < 0·05). Strong correlations were found between TE values and ALT (P < 0·005), GGT (P < 0·0001), Body mass index (P < 0·05), HOMA index (P < 0·05), HDL-cholesterol (P < 0·05) and triglycerides (P < 0·0001).

Conclusions  We can assert that (i) liver stiffness, measured by TE, strongly correlates with liver enzyme levels in patients with TS ; (ii) the increased liver stiffness in patients with TS with biochemical signs of liver dysfunction is significantly related to metabolic syndrome parameters; (iii) TE may be an useful tool to select among patients with TS with elevated liver enzymes or other metabolic risk factors, those who deserve more invasive diagnostic procedures, namely liver biopsy, for the best characterisation of liver damage.

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