We review recent understanding of the pathophysiology, molecular biology, and management of Turner syndrome.
Sophisticated genetic techniques are able to detect mosaicism in one-third of individuals previously thought to have monosomy X. Prenatal detection using maternal blood should permit noninvasive detection of most fetuses with an X chromosome abnormality. Disproportionate growth with short limbs has been documented in this condition, and a target gene of short stature homeobox, connective tissue growth factor (Ctgf), has been described. Liver disease is more common in Turner syndrome than previously recognized. Most girls have gonadal failure. Spontaneous puberty and menarche is more commonly seen in girls with XX mosaicism. Low-dose estrogen replacement therapy may be given early to induce a more normal onset and tempo of puberty. Oocyte donation for assisted reproduction carries a substantial risk, particularly if the woman has known cardiac or aortic disease. Neurodevelopmental differences in Turner syndrome are beginning to be correlated with differences in brain anatomy.
An increased understanding of the molecular basis for aspects of this disorder is now developing. In addition, a renewed focus on health maintenance through the life span should provide better general and targeted healthcare for these girls and women.
aPediatric Endocrine Unit, Department of Pediatrics, Massachusetts General Hospital
bGenetics Residency Program, Harvard Medical School
cBoston Children's Hospital
dReproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital
eGenetics Unit, Mass General Hospital for Children, Massachusetts, Boston, USA
Correspondence to Lynne L. Levitsky, MD, Associate Professor of Pediatrics, Harvard Medical School, and Chief of Pediatric Endocrinology, Department of Pediatrics, Massachusetts General Hospital, 175 Cambridge St., Boston, MA 02114, USA. Tel: +1 617 726 5790; fax: +1 617 643 0395; e-mail: LLevitsky@mgh.harvard.edu