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Longitudinal Study of Liver Enzymes and Serum Levels of Estradiol During Hormonal Replacement Therapy in Patients With Turner Syndrome

Pinheiro, Virgínia S. MD; Gallicchio, Carla T. MD, PhD; Alves, Solange T. F. MD, PhD; Guimarães, Marília M. MD, PhD

doi: 10.1097/01.ten.0000257435.71801.c1
Case Report

Women with Turner syndrome (TS) have an increased risk of developing chronic liver disease. The effects of estrogens on liver function remain controversial.

Objectives: We evaluated the effects of estrogens on liver function of TS patients receiving conjugated equine estrogens (CEE) and 17β percutaneous estradiol (E2P).

Patients and Methods: Twenty-three patients with TS were assessed. Evaluation included height and weight measurement, breast development assessment, and laboratory evaluation (aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyl transferase (GGT), and estradiol). Patients were classified into 2 groups: group 1, induced puberty (n = 19) group 2, spontaneous puberty without HRT (n = 4). CEE was prescribed to group 1 for 12 months and after this period they received E2P for 12 months. Medroxyprogesterone acetate was administered orally during the study. All patients were evaluated at baseline and in group 1, again after 12 and 24 months.

Results: There was significant gain in height and weight. Rise in estradiol levels was observed at 12 and 24 months with higher levels obtained with CEE use. In group 2, liver enzymes were normal in all patients. In group 1, increased levels of AST and GGT were observed at baseline (n = 2–11% and 5–26%, respectively). During the study, 48% of patients (n = 9) developed abnormal levels of GGT and 26% (n = 5) developed abnormal levels of AST.

Conclusions: We found elevated liver enzymes in patients having TS during oral estrogen treatment.

From the Endocrinology Unit, Hospital Clementino Fraga Filho (HUCFF), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.

Reprints: Virgínia Soares Pinheiro, Rua Professor Otacílio, 112/ap. 903 Santa Rosa, Niterói, RJ CEP 24240-670, Brazil. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.