TURNER SYNDROME - FINAL HEIGHT, GLUCOSE-TOLERANCE, BONE-DENSITY AND PSYCHOSOCIAL STATUS IN 25 ADULT PATIENTS

The information available on the medical and psychosocial status of patients with Turner syndrome beyond the paediatric age group is scarce. We therefore studied 25 unselected women with cytogenetically proven Turner syndrome (age 20-50 years), who never received any growth-promoting therapy, and ten control women (25-48 years). In addition to anthropometric measurements, an oral glucose tolerance test was performed, auto-antibodies to endocrine tissues were studied, bone mineral density of the forearm was measured by single photon densitometry, and information about the psychosocial distress of the patients was obtained. Adult height averaged 148.7 +/- 1.1 cm (mean +/- SE), which was 16 cm below the mean of adult women from a similar background. In Turner patients, final height correlated significantly with mid-parental height (final height = 0.67 x MPH + 32.1; r = 0.69). Body mass index was increased in Turner patients (25.6 + 1.3 kg/m(2)) compared to controls (21.4 +/- 0.6; P < 0.006). Six patients (25%) had impaired glucose tolerance or overt diabetes mellitus (one patient). Insulin release was augmented but delayed in the Turner group, and the area under the insulin stimulation curve was correlated to body mass index (r = +0.54, P < 0.01). Thyroid antibodies were detected in nine patients (37.5%). On average, bone density of the forearm was only marginally reduced compared to the age-dependent normal range. All women were employed, while only one of the Turner women was married. As a group, the subjects expressed greater distress due to infertility compared to short stature. These data demonstrate a high degree of impaired glucose tolerance and hyperinsulinism in adult Turner women, which - together with increased body fat - potentially increase the cardiovascular risk for these patients. In contrast, early osteoporosis as well as subjective dissatisfaction with attained height seem to be of secondary importance.