Clinical and Genotypic Insights into Turner Syndrome

Emphasis on Cardiovascular Abnormalities

Authors

DOI:

https://doi.org/10.15605/jafes.040.02.24

Keywords:

Turner syndrome, genotype-phenotype associations, cardiovascular abnormalities, karyotyping, clinical characteristics

Abstract

Objective. Turner syndrome (TS) is a genetic disorder characterized by X chromosome abnormalities in females. It
presents with various clinical features, including short stature and cardiovascular anomalies. Limited awareness and diagnostic facilities contribute to the underdiagnosis of TS in India. The current study aims to explore genotype-phenotype associations with clinical characteristics and cardiovascular abnormalities in TS patients in India.
Methodology. A cross-sectional study involving 40 TS patients underwent clinical assessments and karyotyping. Data on demographics, anthropometry, Turner stigmata, cardiovascular evaluation, neurocognitive assessment and biochemical parameters were collected. The statistical analysis was conducted utilizing Statistical Package for Social Sciences (SPSS) version 27.0.
Results. Monosomy 45, X (55%) was the most prevalent genotype, with notable differences in age at diagnosis and height standard deviation score among genotypes. Thirty-five percent (35%) of participants had cardiovascular abnormalities, with a higher prevalence in the monosomy group. Lower IQ scores and increased thyroid autoimmunity were associated with specific genotypes. Additionally, a greater occurrence of skeletal and cutaneous stigmata, including cubitus valgus and multiple nevi, was observed in the monosomy group.
Conclusion. The study underscores the significance of genotype-phenotype associations in TS, emphasizing personalized management strategies. Early detection using sophisticated technologies like MRI, comprehensive assessments and assisted personalized management strategies to individual genetic profiles may improve cardiovascular and overall health outcomes in Turner syndrome patients.

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Author Biographies

Mounam Chattopadhyay, Nil Ratan Sircar Medical College, Kolkata, West Bengal India

Department of Endocrinology, Nil Ratan Sircar Medical College, Kolkata, West Bengal India

Anindya Mukherjee , Bristol Heart Institute, United Kingdom

Department of Adult Congenital Heart Disease, Bristol Heart Institute, United Kingdom

 

Pranab Sahana, Institute of Post Graduate Medical Education and Research, Kolkata, India

Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, India

References

1. Zhang F, Zhang Z. Advances in the study of the diagnosis and treatment of Turner syndrome. J China-Japan Hosp. 2015;29:192-4.

2. Maiti A, Chatterjee S. Turner syndrome: Fifteen years' experience in India. J Obstet Gynaecol India. 2014;64(Suppl 1):121-3. https://pubmed.ncbi.nlm.nih.gov/25404835 https://pmc.ncbi.nlm.nih.gov/articles/PMC4228024 https://doi.org/10.1007/s13224-013-0411-5

3. Cui X, Cui Y, Shi L, Luan J, Zhou X, Han J. A basic understanding of Turner syndrome: Incidence, complications, diagnosis, and treatment. Intractable Rare Dis Res. 2018;7(4):223-8. https://pubmed.ncbi.nlm.nih.gov/30560013 https://pmc.ncbi.nlm.nih.gov/articles/PMC6290843 https://doi.org/10.5582/irdr.2017.01056

4. Cramer JW, Bartz PJ, Simpson PM, Zangwill SD. The spectrum of congenital heart disease and outcomes after surgical repair among children with Turner syndrome: A single-center review. Pediatr Cardiol. 2014;35(2):253-60. https://pubmed.ncbi.nlm.nih.gov/23933717 https://doi.org/10.1007/s00246-013-0766-5

5. Birjiniuk A, Weisman AG, Laternser C, et al. Cardiovascular manifestations of Turner Syndrome: Phenotypic differences between karyotype subtypes. Pediatr Cardiol. 2024;45(7):1407-14. https://pubmed.ncbi.nlm.nih.gov/37147524 https://doi.org/10.1007/s00246-023-03159-0

6. Sun W, Li T. Analysis of cardiovascular diseases in Turner syndrome. J Clin Pediatr. 2014; 32:195-8.

7. Chen RM, Zhang Y, Yang XH, Lin XQ, Yuan X. Thyroid disease in Chinese girls with Turner syndrome. J Pediatr Endocrinol Metab. 2015;28(1-2):201-5. https://pubmed.ncbi.nlm.nih.gov/25229413 https://doi.org/10.1515/jpem-2014-0199

8. Climie EA, Rostad K. Test review: Wechsler Adult Intelligence Scale, 4th ed. J Psychoeduc Assess. 2011;29(6):581-6. https://doi.org/10.1177/0734282911408707

9. Ranjan A, Agrawal NK, Singh SK, et al. Clinical profile of patients of turner syndrome (TS) with karyotype-phenotype corelation from a tertiary care hospital in Eastern Uttar Pradesh (UP), India. Indian J Obstet Gynecol Res. 2023;10(3):307-12. https://doi.org/10.18231/j.ijogr.2023.062

10. Al Alwan I, Al Khawari M, Amir I. Turner syndrome genotype and phenotype and their effect on presenting features and timing of diagnosis. Int J Health Sci (Qassim). 2014;8(2):195-202. https://pubmed.ncbi.nlm.nih.gov/ 25246887 https://pmc.ncbi.nlm.nih.gov/articles/PMC4166992 https://doi.org/10.12816/0006086

11. Reddy Danda VS, Sreedevi P, Arun G, Rao PS. Growth hormone treatment in Turner’s syndrome: A real-world experience. Indian J Endocr Metab. 2017;21(3):378-81. https://pubmed.ncbi.nlm.nih.gov/28553590 https://pmc.ncbi.nlm.nih.gov/articles/PMC5434718 https://doi.org/10.4103/ijem.IJEM_36_17

12. Gravholt CH, Andersen NH, Conway GS, et al. Clinical practice guidelines for the care of girls and women with Turner syndrome: Proceedings from the 2016 Cincinnati International Turner Syndrome Meeting. Eur J Endocrinol. 2017;177(3): G1-70. https://pubmed.ncbi.nlm.nih.gov/28705803 https://doi.org/10.1530/EJE-17-0430

13. Yeşilkaya E, Bereket A, Darendeliler F, et al. Turner syndrome and associated problems in Turkish children: A multicenter study. J Clin Res Pediatr Endocrinol. 2015;7(1):27-36. https://pubmed.ncbi.nlm.nih.gov/25800473 https://pmc.ncbi.nlm.nih.gov/articles/PMC4439889 https://doi.org/10.4274/jcrpe.1771

14. Ko JM. Genetic Syndromes associated with congenital heart disease. Korean Circ J. 2015;45(5):357-61. https://pubmed.ncbi.nlm.nih.gov/26413101 https://pmc.ncbi.nlm.nih.gov/articles/PMC4580692 https://doi.org/10.4070/kcj.2015.45.5.357

15. Trolle C, Nielsen MM, Skakkebæk A, et al. Widespread DNA hypomethylation and differential gene expression in Turner syndrome. Sci Rep. 2016;6:34220. https://pubmed.ncbi.nlm.nih.gov/27687697 https://pmc.ncbi.nlm.nih.gov/articles/PMC5043230 https://doi.org/10.1038/srep34220

16. Corbitt H, Morris SA, Gravholt CH, Mortensen KH, Tippner-Hedges R, Silberbach M, Maslen CL; GenTAC Registry Investigators. TIMP3 and TIMP1 are risk genes for bicuspid aortic valve and aortopathy in Turner syndrome. PLoS Genet. 2018; 14(10):e1007692. https://pubmed.ncbi.nlm.nih.gov/30281655 https://pmc.ncbi.nlm.nih.gov/articles/PMC6188895 https://doi.org/10.1371/journal.pgen.1007692

17. Mondal S, Bhattacharjee R, Chowdhury S, Mukhopadhyay S. Karyotype-phenotype correlation in Turner syndrome at a single center in Eastern India. Indian Pediatr. 2021;58(1):34-7. https://pubmed.ncbi.nlm.nih.gov/33452775

18. Aversa T, Li Pomi A, Pepe G, et al. Growth hormone treatment to final height in Turner syndrome: Systematic review. Clin Ther. 2024; 46(2):146-53. https://pubmed.ncbi.nlm.nih.gov/38151406 https://doi.org/10.1016/j.clinthera.2023.12.004

19. Ouarezki Y, Cizmecioglu FM, Mansour C, et al. Measured parental height in Turner syndrome - A valuable but underused diagnostic tool. Eur J Pediatr. 2018;177(2):171-9. https://pubmed.ncbi.nlm.nih.gov/29255949 https://pmc.ncbi.nlm.nih.gov/articles/PMC5758685 https://doi.org/10.1007/s00431-017-3045-2

20. Noordman ID, van der Velden JA, Timmers HJ, et al. Karyotype - phenotype associations in patients with Turner syndrome. Pediatr Endocrinol Rev. 2019;16(4):431-40. https://pubmed.ncbi.nlm.nih.gov/31245938 https://doi.org/10.17458/per.vol16.2019.nvt.karyotypeturnersyndrome

21. Elleuch M, Feki MM, Kammoun M, et al. Descriptive analyses of Turner syndrome: 49 cases in Tunisia. Ann Endocrinol (Paris). 2010;71(2):111-6. https://pubmed.ncbi.nlm.nih.gov/20153455 https://doi.org/10.1016/j.ando.2009.12.013

22. Chou YY, Wang CJ, Lin CH, Chung HT, Lo FS. Association between cardiovascular anomalies and karyotypes in Turner syndrome patients in Taiwan: A local cohort study. Pediatr Neonatol. 2020;61(2):188-94. https://pubmed.ncbi.nlm.nih.gov/31672476 https://doi.org/10.1016/j.pedneo.2019.10.001

23. Yiğit H, Önder A, Özgür S, Aycan Z, Karademir S, Doğan V. Cardiac MRI and 3D contrast-enhanced MR angiography in pediatric and young adult patients with Turner syndrome. Turk J Med Sci. 2017;47(1):127-33. https://pubmed.ncbi.nlm.nih.gov/28263479 https://doi.org/10.3906/sag-1511-3

24. Somerville S, Rosolowsky E, Suntratonpipat S, Girgis R, Goot BH, Tham EB. Cardiac magnetic resonance imaging in pediatric Turner syndrome. J Pediatr. 2016;175:111-5.e1. https://pubmed.ncbi.nlm.nih.gov/27233524 https://doi.org/10.1016/j.jpeds.2016.04.080

25. Björlin Avdic H, Kleberg JL, van der Poll M, et al. Cognitive profile in adult women with turner syndrome: IQ split and associations with ADHD and ASD. Cogn Neuropsychiatry. 2023;28(3):207-25. https://pubmed.ncbi.nlm.nih.gov/37165648 https://doi.org/10.1080/13546805.2023.2209312

26. Fezza JI, Rau S, Clary L, et al. Spectrum of neuropsychological challenges in Turner syndrome. Front Endocrinol (Lausanne). 2024; 15:1461103. https://pubmed.ncbi.nlm.nih.gov/39624818 https://pmc.ncbi.nlm.nih.gov/articles/PMC11608949 https://doi.org/10.3389/fendo.2024.1461103

27. Leppig KA, Sybert VP, Ross JL, et al. Phenotype and X inactivation in 45,X/46,X,r(X) cases. Am J Med Genet A. 2004;128A(3):276–284. https://pubmed.ncbi.nlm.nih.gov/15216549 https://doi.org/10.1002/ajmg.a.30002

28. Elsheikh M, Wass JA, Conway GS. Autoimmune thyroid syndrome in women with Turner's syndrome—the association with karyotype. Clin Endocrinol (Oxf). 2001;55(2):223-6. https://pubmed.ncbi.nlm.nih.gov/11531929 https://doi.org/10.1046/j.1365-2265.2001.01296.x

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Published

2025-11-10

How to Cite

Chattopadhyay, M., Mukherjee , A., & Sahana, P. (2025). Clinical and Genotypic Insights into Turner Syndrome: Emphasis on Cardiovascular Abnormalities. Journal of the ASEAN Federation of Endocrine Societies, 40(2), 132–137. https://doi.org/10.15605/jafes.040.02.24

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Original Articles