The changing face of Turner syndrome
Open accessAbstract
Turner syndrome (TS) is a condition in females missing the second sex chromosome (45,X) or parts thereof. It is considered a rare genetic condition and is associated with a wide range of clinical stigmata, such as short stature, ovarian dysgenesis, delayed puberty and infertility, congenital malformations, endocrine disorders, including a range of autoimmune conditions and type 2 diabetes, and neurocognitive deficits. Morbidity and mortality are clearly increased compared with the general population and the average age at diagnosis is quite delayed. During recent years it has become clear that a multidisciplinary approach is necessary toward the patient with TS. A number of clinical advances has been implemented, and these are reviewed. Our understanding of the genomic architecture of TS is advancing rapidly, and these latest developments are reviewed and discussed. Several candidate genes, genomic pathways and mechanisms, including an altered transcriptome and epigenome, are also presented.
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SHOX is known to be associated with decreased height in TS.
“except for SHOX, known to be associated with the decreased height in TS116 (for review see Gravholt et al. 202317).”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [17]
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Retarded development of XO conceptuses during early pregnancy in the mouse
Burgoyne, P. S., Tam, P. P. L., & Evans, E. P. (1983) · Reproduction · doi:10.1530/jrf.0.0680387 · Cited by 83 · see citing works
Cook, K. D., Shpargel, K. B., Starmer, J., Whitfield-Larry, F., Conley, B., Allard, D. E., Rager, J. E., Fry, R. C., Davenport, M. L., Magnuson, T., et al. (2015) · Immunity · doi:10.1016/j.immuni.2015.09.002 · Cited by 83 · see citing works
Ostberg, J. E., Thomas, E. L., Hamilton, G., Hosseinzadeh‐Attar, M. J., Bell, J. D., & Conway, G. S. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-1939 · Cited by 83 · see citing works
Taboada, M., Santen, R., Lima, J., Hossain, J., Singh, R., Klein, K. O., & Mauras, N. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-1449 · Cited by 82 · see citing works
Bronshtein, M., Zimmer, E. Z., & Blazer, S. (2003) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2003.230 · Cited by 82 · see citing works
Castronovo, C., Rossetti, R., Rusconi, D., Recalcati, M. P., Cacciatore, C., Beccaria, E., Calcaterra, V., Invernizzi, P., Larizza, D., Finelli, P., et al. (2013) · Human Reproduction · doi:10.1093/humrep/det436 · Cited by 82 · see citing works
Sharma, A., Jamil, M. A., Nuesgen, N., Schreiner, F., Priebe, L., Hoffmann, P., Herns, S., Nöthen, M. M., Fröhlich, H., Oldenburg, J., et al. (2015) · Clinical Epigenetics · doi:10.1186/s13148-015-0112-2 · Cited by 81 · see citing works
The influence of renal and cardiovascular abnormalities on blood pressure in Turner syndrome
Nathwani, Unwin, Brook, & Hindmarsh (2000) · Clinical Endocrinology · doi:10.1046/j.1365-2265.2000.00961.x · Cited by 80 · see citing works
Carrascosa, A., Gussinyé, M., Terradas-Montana, P., Yeste, D., Audı́, L., & Vicens-Calvet, E. (2000) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.2000.15.10.2005 · Cited by 80 · see citing works
Child, C. J., Zimmermann, A. G., Chrousos, G. P., Cummings, E., Deal, C. L., Hasegawa, T., Jia, N., Lawrence, S., Linglart, A., Loche, S., et al. (2019) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2018-01189 · Cited by 80 · see citing works
Use of Percutaneous Estrogen Gel for Induction of Puberty in Girls with Turner Syndrome
Piippo, S., Lenko, H. L., Kainulainen, P., & Sipilä, I. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-032069 · Cited by 79 · see citing works
Determinants of medical care for young women with Turner syndrome
Devernay, M., Ecosse, E., Coste, J., & Carel, J.-C. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-0495 · Cited by 79 · see citing works
Shone Complex: An Under-recognized Congenital Heart Disease With Substantial Morbidity in Adulthood
Aslam, S., Khairy, P., Shohoudi, A., Mercier, L., Dore, A., Marcotte, F., Miró, J., Ávila, P., Ibrahim, R., Asgar, A., et al. (2016) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2016.09.005 · Cited by 79 · see citing works
Rhie, S. K., Yao, L., Luo, Z., Witt, H. N., Schreiner, S., Guo, Y., Perez, A. A., & Farnham, P. (2018) · Genome Research · doi:10.1101/gr.228809.117 · Cited by 79 · see citing works
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Cited by
Sorted by citations
Clinical practice guidelines for the care of girls and women with Turner syndrome.
Gravholt, C. H., Andersen, N. H., Christin-Maitre, S., Davis, S. M., Duijnhouwer, A., Gawlik, A., Maciel-Guerra, A. T., Gutmark-Little, I., Fleischer, K., Hong, D., et al. (2024) · European Journal of Endocrinology · doi:10.1093/ejendo/lvae050 · Cited by 224 · see citing works
Organ Abnormalities Caused by Turner Syndrome
Yoon, S. H., Kim, G. Y., Choi, G. T., & Tae, J. (2023) · Cells · doi:10.3390/cells12101365 · Cited by 41 · see citing works
“Although no clinically relevant abnormalities in the GH/insulin-like growth factor (IGF) axis have been reported in patients with TS [5], early recognition and timely investigation of TS can lead to better outcomes.”
BackgroundMethodSociety for endocrinology guideline for understanding, diagnosing and treating female hypogonadism
Jayasena, C. N., Devine, K., Barber, K., Comninos, A. N., Conway, G. S., Crown, A. L., Davies, M. C., Ewart, A., Seal, L., Smyth, A., et al. (2024) · Clinical Endocrinology · doi:10.1111/cen.15097 · Cited by 39 · see citing works
“113,143 Whilst a significant proportion of women with TS are delayed in diagnosis, or undergo pubertal ‐ induction relatively late, and some may never be detected, it is imperative that all women with a diagnosis of TS and POI receive appropriate 17 β ‐ estradiol replacement therapy.”
InfluentialThe risk factors, pathogenesis and treatment of premature ovarian insufficiency
Huang, Y., Liu, Z., Geng, Y., Li, F., Hu, R., Song, Y., Zhang, M., & Song, K. (2025) · Journal of Ovarian Research · doi:10.1186/s13048-025-01714-2 · Cited by 37 · see citing works
“Turner syndrome affects around 64 per 100,000 newborns [12], with over 80% of patients experiencing absent sponta-neous menstruation; even among those with spontane-ous menstruation, about one-third are diagnosed with POI [13].”
Out of the Silence: Insights into How Genes Escape X-Chromosome Inactivation
Peeters, S. B., Posynick, B. J., & Brown, C. J. (2023) · Epigenomes · doi:10.3390/epigenomes7040029 · Cited by 33 · see citing works
“The myriad of clinical presentations of Turner syndrome (TS) in 45,X individuals have long been attributed to the missing escapees from a second sex chromosome (see [45] for a recent review).”
BackgroundClinical pregnancy in Turner syndrome following re-implantation of cryopreserved ovarian cortex
Dunlop, C. E., Jack, S., Telfer, E. E., Zahra, S., & Anderson, R. (2023) · Journal of Assisted Reproduction and Genetics · doi:10.1007/s10815-023-02905-w · Cited by 32 · see citing works
“Turner syndrome (TS) is a rare condition affecting approximately 50 in 100,000 women [1].”
BackgroundMartin‐Giacalone, B. A., Lin, A. E., Rasmussen, S. A., Kirby, R. S., Nestoridi, E., Liberman, R. F., Agopian, A. J., Carey, J. C., Cragan, J. D., Forestieri, N., et al. (2023) · American Journal of Medical Genetics Part A · doi:10.1002/ajmg.a.63181 · Cited by 28 · see citing works
“Another limitation of the current Turner syndrome literature is the exclusion of non-live birth outcomes (Berglund et al., 2020; Gravholt et al., 2022; Stochholm et al., 2006), which can result in underestimates of some severe birth defects (Heinke et al., 2020).”
BackgroundThe impact of chromosomal sex on cardiometabolic health and disease
Wiese, C. B., Avetisyan, R., & Reue, K. (2023) · Trends in Endocrinology and Metabolism · doi:10.1016/j.tem.2023.07.003 · Cited by 28 · see citing works
Johannsen, E. B., Just, J., Viuff, M. H., Okholm, T. L. H., Pedersen, S. B., Lauritsen, K. M., Trolle, C., Pedersen, M. G. B., Chang, S., Fedder, J., et al. (2022) · Frontiers in Genetics · doi:10.3389/fgene.2022.928874 · Cited by 24 · see citing works
“Recent studies have demonstrated that changes in the transcriptome and methylome may explain part of the biological mechanisms underlying the phenotypes of sex chromosome aneuploidies (SCAs) (Sharma et al., 2015; Raznahan et al., 2018; Zhang X. et al., 2020; Gravholt et al., 2022).”
BackgroundKhan, N., Farooqui, A., & Ishrat, R. (2024) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-024-03337-0 · Cited by 19 · see citing works
“Most TS women depend on assisted reproductive technology (ART) or alternative options such as fostering and adoption to become parents [49].”
BackgroundThe epidemiology of disorders of sex development
Berglund, A., Chang, S., Lind‐Holst, M., Stochholm, K., & Gravholt, C. H. (2025) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2025.102002 · Cited by 17 · see citing works
Primary Amenorrhea and Premature Ovarian Insufficiency
Yatsenko, S. A., Witchel, S. F., & Gordon, C. M. (2024) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2024.01.009 · Cited by 17 · see citing works
A prospective study of lipids in adult women with Turner syndrome
Sandahl, K. J., Just, J., Erlandsen, M., Mortensen, K. H., Andersen, N. H., & Gravholt, C. H. (2023) · Journal of the Endocrine Society · doi:10.1210/jendso/bvad124 · Cited by 14 · see citing works
“Likewise, inclusion of anthropometric measurements and information on physical activity in future studies would provide valuable information, because women with TS are prone to a more sedentary lifestyle [1].”
InfluentialXYGO: proposing a new holistic measure of gender identity and sexual orientation
Cristofaro, A. D., Jannini, T. B., Colonnello, E., Limoncin, E., Mollaioli, D., Ciocca, G., Sansone, A., & Jannini, E. A. (2025) · Nature Reviews Urology · doi:10.1038/s41585-025-01041-7 · Cited by 14 · see citing works
Fedder, J., Fagerberg, C. R., Jørgensen, M. W., Gravholt, C. H., Berglund, A., Knudsen, U. B., & Skakkebaek, A. H. (2023) · Basic and Clinical Andrology · doi:10.1186/s12610-023-00212-z · Cited by 13 · see citing works
“Men with a 45,X cell line were referred for TTE and RUS at local hospitals due to an increased prevalence of congenital heart and kidney malformations in female 45,X patients [18].”
BackgroundTurner syndrome: fertility counselling in childhood and through the reproductive lifespan
Bollig, K. J., Mainigi, M. A., Senapati, S., Lin, A. E., Levitsky, L. L., & Bamba, V. (2022) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0000000000000784 · Cited by 13 · see citing works
Gayete-Lafuente, S., Turan, V., & Oktay, K. (2023) · Journal of Assisted Reproduction and Genetics · doi:10.1007/s10815-023-02932-7 · Cited by 12 · see citing works
“The severity and speed of oocyte depletion among TS girls vary after birth, and they often present with extremely low AMH levels before reaching adolescence [38].”
BackgroundWang, G., Liu, X., Wang, M., Wang, J., Zhang, Z., Allegaert, K., Mei, D., Zhang, Y., Luo, S., Fang, Y., et al. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1324160 · Cited by 9 · see citing works
“The relationship between TS karyotype and clinical phenotype is not well understood due to its wide age distribution, variability in the de fi nition of its clinical phenotype, and differences in the X mosaicism of different tissues (2, 3).”
Background(2024) · Fertility and Sterility · doi:10.1016/j.fertnstert.2024.06.003 · Cited by 11 · see citing works
Thunström, S., Thunström, E. Ö., Naessén, S., Berntorp, K. E., Kitlinski, M. L., Ekman, B., Wahlberg, J., Bergström, I. B., Isaksson, M., Basic, C., et al. (2024) · American Heart Journal · doi:10.1016/j.ahj.2024.11.007 · Cited by 9 · see citing works
Tanoshima, M., Tanoshima, R., Takase, H., Yamamoto, D., Aoki, S., Sakakibara, H., & Miyagi, E. (2025) · Congenital Anomalies · doi:10.1111/cga.70002 · Cited by 9 · see citing works
Seeman, M. V. (2023) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2023.04.005 · Cited by 9 · see citing works
Turner syndrome-omphalocele association: incidence, karyotype, phenotype and fetal outcome
Bedei, I., Gloning, K., Joyeux, L., Meyer‐Wittkopf, M., Willner, D., Krapp, M., Scharf, A., Degenhardt, J., Heling, K., Kozlowski, P., et al. (2023) · Prenatal Diagnosis · doi:10.1002/pd.6302 · Cited by 8 · see citing works
“Recent evidence suggests that the karyotype– phenotype relation cannot be explained by the gene dosage alone and epigenetic mechanisms may influence autosomal gene expression.(34,35) The prenatal phenotype includes fetal hydrops, cystic hygroma, congenital heart defects primarily affecting the left outflow”
BackgroundJuul, A., Gravholt, C. H., Vos, M. D., Koledova, E. B., & Cools, M. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1160884 · Cited by 8 · see citing works
“Management of Turner syndrome requires active and specialized involvement from disciplines such as cardiology, ear/ nose/throat, ophthalmology and orthopedics (4, 24).”
BackgroundMethodAnalysis of genetic variability in Turner syndrome linked to long-term clinical features
Suntharalingham, J. P., Ishida, M., Cameron‐Pimblett, A., McGlacken-Byrne, S. M., Buonocore, F., del Valle, I., Madhan, G. K., Brooks, T., Conway, G. S., & Achermann, J. C. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1227164 · Cited by 9 · see citing works
“The age of presentation in TS varies (2).”
InfluentialCRELD1 variants are associated with bicuspid aortic valve in Turner syndrome
Pinnaro, C. T., Beck, C. B., Major, H. J., & Darbro, B. W. (2023) · Human Genetics · doi:10.1007/s00439-023-02538-0 · Cited by 8 · see citing works
“2007), but no definitive phenotype-karyotype correlations have been made with regards to CHD in TS (Gravholt et al. 2022).”
BackgroundMethodInfluentialBedei, I., Gehrke, T., Gloning, K., Meyer‐Wittkopf, M., Willner, D., Krapp, M., Scharf, A., Degenhardt, J., Heling, K., Kozlowski, P., et al. (2023) · Prenatal Diagnosis · doi:10.1002/pd.6320 · Cited by 7 · see citing works
Image-Based Face Recognition Techniques Used in Disease Detection Approaches: A Survey
Salman, G. A., Kadhim, I. J., & Al-Badri, A. H. (2024) · Journal of Techniques · doi:10.51173/jt.v6i1.1966 · Cited by 8 · see citing works
Kucharska, A., Witkowska–Sędek, E., Erazmus, M., Artemniak-Wojtowicz, D., Krajewska, M., & Pyrżak, B. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms251810169 · Cited by 9 · see citing works
Approach to the Patient With Turner Syndrome
Turner, H. E., Johannsen, E. B., Smyth, A., Orchard, E., & Gravholt, C. H. (2025) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaf517 · Cited by 11 · see citing works
Dermatological concerns for women and girls with turner syndrome
Rodriguez‐Buritica, D., Mones, M., Prakash, S. K., Rivera, M., Aldrich, M. B., Rogge, M. N., & Richardson, K. M. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2023.1235187 · Cited by 6 · see citing works
“Turner syndrome (TS) is a common chromosome condition that affects approximately 64 per 100,000 in newborns (1).”
BackgroundMondal, S., Gargari, P., Nagendra, L., Mandal, S., Kumar, R. C., Shah, P., Haldar, M., Chowdhury, S., & Mukhopadhyay, S. (2023) · Clinical Endocrinology · doi:10.1111/cen.14957 · Cited by 7 · see citing works
Krzyścin, M., Sowińska-Przepiera, E., Gruca-Stryjak, K., Soszka-Przepiera, E., Syrenicz, I., Przepiera, A., Bumbulienė, Ž., & Syrenicz, A. (2024) · Biomedicines · doi:10.3390/biomedicines12051034 · Cited by 7 · see citing works
The transcriptomic landscape of monosomy X (45,X) during early human fetal and placental development
Suntharalingham, J. P., del Valle, I., Buonocore, F., McGlacken-Byrne, S. M., Brooks, T., Ogunbiyi, O. K., Liptrot, D., Dunton, N. J., Madhan, G. K., Metcalfe, K., et al. (2025) · Communications Biology · doi:10.1038/s42003-025-07699-4 · Cited by 7 · see citing works
“They have also provided extensive supplemental data to be transparent about the results of the study.”
Ahern, D. T., Bansal, P., Faustino, I. V., Chambers, O. M., Banda, E. C., Glatt-Deeley, H. R., Massey, R. E., Kondaveeti, Y., & Pinter, S. F. (2025) · The American Journal of Human Genetics · doi:10.1016/j.ajhg.2025.01.013 · Cited by 6 · see citing works
Bedei, I. A., Bruder, J., Lund, I. C. B., Thomsen, S. H., Vogel, I., Maciel‐Guerra, A. T., Álvarez‐Nava, F., Crenshaw, M., Axt-Fliedner, R., Gravholt, C. H., et al. (2025) · American Journal of Medical Genetics Part C Seminars in Medical Genetics · doi:10.1002/ajmg.c.32136 · Cited by 6 · see citing works
Song, G., Su, L., Wang, X., Huang, Z., Wang, S., Fu, Q., & Wang, P. (2025) · Neurocomputing · doi:10.1016/j.neucom.2025.131060 · Cited by 6 · see citing works
Ruan, X., Cheng, J., Du, J., Jin, F., Gu, M., Jü, R., Wu, Y., Li, L., Wang, Y., Jiang, L., et al. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1137940 · Cited by 6 · see citing works
Choi, J. E., Park, M. J., Yu, J., & Kim, H. S. (2024) · Annals of Pediatric Endocrinology & Metabolism · doi:10.6065/apem.2346246.123 · Cited by 4 · see citing works
Symmetry of the face – Review of a complex matter
Kessler, P. A. W. H., Timmer, V. C. M. L., & Lie, S. A. N. (2024) · Journal of Oral and Maxillofacial Surgery Medicine and Pathology · doi:10.1016/j.ajoms.2024.11.010 · Cited by 5 · see citing works
Comprehensive Oral Diagnosis and Management for Women with Turner Syndrome
Tallón‐Walton, V., Molins, M. S., Hu, W., Martínez‐Abadías, N., Casado, A., & Manzanares‐Céspedes, M. C. (2024) · Diagnostics · doi:10.3390/diagnostics14070769 · Cited by 6 · see citing works
“…of TS include primary hypogonadism, skeletal anomalies, congenital heart diseases, gastrointestinal and hepatic pathologies, visual and auditory problems, lymphatic and cutaneous ailments, renal malformations and hypertension, as well as mental, neurocognitive and behavioral health issues [8,9].”
BackgroundWitkowska-Krawczak, E., Erazmus, M., Majcher, A., Pyrżak, B., & Kucharská, A. (2023) · Frontiers in Pediatrics · doi:10.3389/fped.2023.1173419 · Cited by 5 · see citing works
“However the progress of genetic and molecular diagnostics allows for the identification of an increasing number of genes within the X chromosome responsible for the occurrence of individual symptoms (4).”
BackgroundElevated levels of neutrophils with a pro-inflammatory profile in Turner syndrome across karyotypes
Just, J., Ridder, L. O. R., Johannsen, E. B., Jensen, J. M. B., Petersen, M. S., Christensen, H. V., Kjærgaard, K., Redder, J. D., Chang, S., Stochholm, K., et al. (2025) · npj Genomic Medicine · doi:10.1038/s41525-025-00467-7 · Cited by 5 · see citing works
“…in TS, which points to a fundamental imbalance in the immune system possibly encompassing low grade in fl ammation 24,25 , increased risk of cardiovascular complications 10 and abnormal body composition with increased fat mass and low muscle mass 26 with the differential methylome and transcriptome.”
Diddhenipothage, S. A. D. M., Beck, K. J., Amiyangoda, C. G. K., Bryce, J., Cima, L., Groote, K. D., Deyanova, Y., Globa, E., Herrmann, G., Juul, A., et al. (2025) · Endocrine Connections · doi:10.1530/ec-24-0477 · Cited by 5 · see citing works
Ding, F., Xu, J., Xiong, J., Li, Q., Cheng, Z., & Deng, L. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1552300 · Cited by 5 · see citing works
Evolution of Health Care in Turner Syndrome
Shankar, R. K., Gravholt, C. H., & Backeljauw, P. F. (2024) · American Journal of Medical Genetics Part C Seminars in Medical Genetics · doi:10.1002/ajmg.c.32124 · Cited by 4 · see citing works
Parental Decision‐Making Following a Prenatal Diagnosis of Turner Syndrome: A Systematic Review
Dorf, I. L. H., Lou, S., & Skakkebaek, A. H. (2025) · American Journal of Medical Genetics Part C Seminars in Medical Genetics · doi:10.1002/ajmg.c.32140 · Cited by 4 · see citing works
Villasmil, M. G. P., Ryckman, K. K., Norris, A. W., & Pinnaro, C. T. (2023) · Hormone Research in Paediatrics · doi:10.1159/000534371 · Cited by 4 · see citing works
“Turner syndrome (TS) is a genetic disorder resulting from complete or partial loss of the second sex chromosome [1].”
Ovarian Insufficiency: Clinical Spectrum and Management Challenges
Stuenkel, C. A. (2024) · Journal of Women s Health · doi:10.1089/jwh.2023.0942 · Cited by 4 · see citing works
“…of premature menopause, or is being evaluated in a research setting utilizing specified genetic test panels, most experts recommend obtaining a karyotype to identify Turner Syndrome (or mosaics), 56,57 or translocations of the long arm of the X chromosome, and testing for Fragile-X premutation.”
Gravholt, C. H. (2024) · Elsevier eBooks · doi:10.1016/b978-0-12-815234-8.00002-1 · Cited by 4 · see citing works
McGlacken-Byrne, S. M., del Valle, I., Xenakis, T., Suntharalingham, J. P., Nel, L., Liptrot, D., Crespo, B., Ogunbiyi, O. K., Niola, P., Brooks, T., et al. (2023) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2023.12.22.572342 · Cited by 4 · see citing works
“…phenotype include a reduction in dosage of genes escaping X chromosome inactivation (XCI escape genes); epigenetic abnormalities; downstream autosomal genetic disruption; and telomere length abnormalities (Trolle et al., 2016; Jackson-Cook, 2019; Rizzolio et al., 2007; Gravholt et al., 2022).”
BackgroundOssama, H. M., Kholeif, S. F., & Elhady, G. M. (2023) · Journal of Human Reproductive Sciences · doi:10.4103/jhrs.jhrs_128_23 · Cited by 3 · see citing works
“[27,28] Marker chromosomes can be detected in about 20% of mosaic TS which could be derived from the X or Y chromosome, and in 6% of cases the marker is derived from a structurally abnormal Y chromosome.”
BackgroundLee, Y. J., Cheon, C. K., Suh, J., Ahn, M. B., Ahn, M. B., Chang, S. H., Lee, J. E., Choi, J., Lim, H. H., Kim, J. H., et al. (2024) · Annals of Pediatric Endocrinology & Metabolism · doi:10.6065/apem.2448272.136 · Cited by 3 · see citing works
van der Zande, J. A., Grewal, J., Franx, A., Hlebowicz, J., Demulier, L., Konings, T. C., Kinsara, A. J., Mwita, J. C., Bal-Theoleyre, L., Mahmeed, W. A., et al. (2025) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwaf574 · Cited by 3 · see citing works
The importance of genetic counselling for turner syndrome transition
Villarreal, E. M. L., Prado, S. C., Schack, A. K., Sánchez, S. Á., Casado, M. A., Krych, Ł., & Garrido-Navas, M. C. (2024) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-024-02547-y · Cited by 3 · see citing works
“…that the foetus may be affected by TS leading to the application of invasive diagnostic techniques; another in the age range between 5 and 20 years due to a height deficit or menstruation problems and a third peak between 30 and 40 years due to the studies carried out for infertility issues [21].”
Thunström, S., Wide, U., Landin‐Wilhelmsen, K., Berntorp, K. E., Bryman, I., Krantz, E., Wahlberg, J., Ekman, B., Isakson, M., Karlsson, A., et al. (2024) · Translational Psychiatry · doi:10.1038/s41398-024-02937-5 · Cited by 3 · see citing works
Krzyścin, M., Gruca-Stryjak, K., Soszka-Przepiera, E., Syrenicz, I., Przepiera, A., Cymbaluk‐Płoska, A., Bumbulienė, Ž., & Sowińska-Przepiera, E. (2023) · Biomedicines · doi:10.3390/biomedicines11123125 · Cited by 3 · see citing works
“A minority of patients retain Y chromosome elements [5].”
BackgroundUncommon presentation: monozygotic twins with Turner syndrome
Rehman, B., Shariff, Y., Arif, M., & Memon, F. (2024) · BMJ Case Reports · doi:10.1136/bcr-2024-262946 · Cited by 3 · see citing works
Cicione, M. E., Wong, A. W., Aragon, E., Hague, C. D., Cirino, A. L., Scimone, E. R., Gochyyev, P., & Lin, A. E. (2025) · American Journal of Medical Genetics Part C Seminars in Medical Genetics · doi:10.1002/ajmg.c.32128 · Cited by 3 · see citing works
Global burden and health inequalities of sex chromosomal DSDs (1990–2021): a GBD 2021 analysis
Su, X., Chen, F., Shi, Z., Tao, Y., Han, X., & Li, X. (2025) · International Urology and Nephrology · doi:10.1007/s11255-025-04677-x · Cited by 2 · see citing works
“KS patients frequently present with cardiac and genital malformations, while TS patients exhibit short stature, congenital heart disease, and horseshoe kidney [6, 13, 15, 36].”
InfluentialTurner syndrome: skin, liver, eyes, dental and ENT evaluation should be improved
Lam, J., Stoppa‐Vaucher, S., Αντωνίου, Μ., Bouthors, T., Arana, I. L. R., Sekarski, N., Rutz, T., Fries, S., Binz, P., Niel, F., et al. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1190670 · Cited by 3 · see citing works
“The distribution of karyotypes in our cohort showed slightly higher proportion of X structural rearrangement than previously published (15).”
BackgroundHypothyroidism and growth hormone deficiency as a complication of Turner Syndrome: Case Report
Aucay, H. A. C., Naula, M. P. N., Lata, G. E. P., Córdova, M., Guaman, M. R. C., Salazar, A. D. R. G., & Nugra, T. M. G. (2023) · Salud Ciencia y Tecnología · doi:10.56294/saludcyt2023438 · Cited by 2 · see citing works
Caracterización de una cohorte de pacientes pediátricas con Síndrome de Turner
Guzmán-Arias, E. C., Grajales-Restrepo, D. A., Zuluaga, N. A., Lopera-Cañaveral, M. V., & Niño-Serna, L. F. (2023) · Andes pediatrica · doi:10.32641/andespediatr.v94i5.4617 · Cited by 2 · see citing works
Zhou, Z., Qiang, J., Hao, N., Guo, X., Yao, F., Yang, H., Jiang, Y., Zhu, H., Chen, S., & Pan, H. (2024) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgae648 · Cited by 2 · see citing works
Berglund, A., Gravholt, C. H., & Stochholm, K. (2025) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgae912 · Cited by 2 · see citing works
Evaluating primary amenorrhea in the primary care setting
Hopkins, L. W., Breiten, K. H., Spero, S., & Moore, G. (2025) · The Nurse Practitioner · doi:10.1097/01.npr.0000000000000311 · Cited by 2 · see citing works
Álvarez‐Nava, F., Crenshaw, M., Bedei, I. A., Soto, M., Maciel‐Guerra, A. T., & Skakkebaek, A. H. (2025) · American Journal of Medical Genetics Part C Seminars in Medical Genetics · doi:10.1002/ajmg.c.32146 · Cited by 2 · see citing works
Turner Syndrome: An Update Review
Alam, J., & Shalini, D. (2024) · International Journal of Innovative Science and Research Technology (IJISRT) · doi:10.38124/ijisrt/ijisrt24may508 · Cited by 2 · see citing works
Lifelong cardiovascular care in Turner syndrome: two cases with review of literature
Moriguchi, S., Mukoyama, Y., Takizawa, F., Ogawa, A., Ogawa, T., Itô, J., Yanagawa, Y., Komiyama, C., Niitsu, R., & Isojima, T. (2024) · Endocrine Journal · doi:10.1507/endocrj.ej24-0038 · Cited by 1 · see citing works
Transition from pediatrics to adult health care in girls with turner syndrome
Sabbadin, C., Marin, L., Manso, J., Mozzato, C., Camozzi, V., Andrisani, A., Sacchetti, C., Mian, C., Scaroni, C. M., Guazzarotti, L., et al. (2024) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2024.2347265 · Cited by 1 · see citing works
“The SHOX protein plays a role in several pathways of the growth plate: decreased SHOX expression explains part of the reduced linear growth in patients with TS [3,5].”
BackgroundA Diagnosis of Turner Syndrome in the Eighth Decade of Life
Kaur, R., & O’Sullivan, S. (2024) · JCEM Case Reports · doi:10.1210/jcemcr/luae104 · Cited by 1 · see citing works
“The delay in diagnosis of TS may result from a lack of syndrome recognition by clinicians, delayed presentation, and/or inadequate genetic analysis (1).”
BackgroundPharmacogenomic studies of fertility outcomes in pediatric cancer survivors – A systematic review
Stenta, T., Assis, M., Ayers, K. L., Tucker, E. J., Halman, A., Gook, D. A., Sinclair, A. H., Elliott, D. A., Jayasinghe, Y., & Conyers, R. K. (2024) · Clinical and Translational Science · doi:10.1111/cts.13827 · Cited by 1 · see citing works
Medical Management of Children with Disorders of Sex Development: An Overview
Yadav, J., Nanda, P. M., & Jain, V. (2024) · Springer eBooks · doi:10.1007/978-981-97-1639-5_53 · Cited by 1 · see citing works
Beroukhim, G., Kastury, R. D., Davidson, K. A., Bergmann, J. M., & Vash‐Margita, A. (2025) · Journal of Pediatric and Adolescent Gynecology · doi:10.1016/j.jpag.2025.02.002 · Cited by 2 · see citing works
Madison, A. M., Applegate, C. D., Stinnett, V., Miranda, D. M., Cross, C., Vaught, K. C. C., Zou, Y. S., & Murry, J. B. (2025) · Scientific Reports · doi:10.1038/s41598-025-89843-y · Cited by 1 · see citing works
Krzyścin, M., Sowińska-Przepiera, E., Bumbulienė, Ž., & Syrenicz, A. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26083679 · Cited by 1 · see citing works
Germ cell and other tumors in individuals with differences in sex development
Witchel, S. F., & Reyes‐Múgica, M. (2025) · CA A Cancer Journal for Clinicians · doi:10.3322/caac.70015 · Cited by 1 · see citing works
“42 The premature loss of oocytes contributes to atypical ovarian development characterized by fibrous stroma, deficient estradiol synthesis, hypergonadotropic hypogonadism, and premature ovarian insufficiency.”
TIPE2: a novel regulatory factor for cardiovascular-related diseases
Li, R., & Guo, Z. (2025) · Journal of Molecular Medicine · doi:10.1007/s00109-025-02564-7 · Cited by 1 · see citing works
“Diabetes is the most common endocrine disease that often leads to cardiovascular disorders [45].”
Johannsen, E. B., Just, J., Chang, S., Skakkebaek, A. H., & Gravholt, C. H. (2025) · Clinical Epigenetics · doi:10.1186/s13148-025-01963-4 · Cited by 1 · see citing works
“Both syndromes are associated with increased incidence of aging-related comorbidities such as osteoporosis, sarcopenia, adiposity, diabetes, metabolic syndrome, as well as cardiovascular disease [10–16].”
Shen, Y., Song, C., Du, Y., Wang, L., Li, X., Shi, Y., Ye, D., Dong, S., & Liu, H. (2025) · Medicine · doi:10.1097/md.0000000000044519 · Cited by 1 · see citing works
“[45,50] TS is a multisystem disorder, with an increasing trend in overall mortality, [44] and women with TS are more likely to experience cardiovascular, diabetic, and osteoporotic complications.”
Shang, D., Wang, Y., Lan, T., Wang, X., Cheng, H., & Zhou, R. (2025) · Cell & Bioscience · doi:10.1186/s13578-025-01464-0 · Cited by 1 · see citing works
“In girls and women with Turner syndrome, the gonads usually become streaks of connective tissue with no germ cells [4, 11].”
InfluentialIncidence and multisystem preadolescent complications of Turner syndrome: a nationwide study
Cha, J. H., Kang, E., Na, J. Y., Ryu, S., Choi, Y., & Kim, J. H. (2025) · Pediatrics & Neonatology · doi:10.1016/j.pedneo.2025.06.009 · Cited by 1 · see citing works
Lewin, L. L., Stadlmeier, M., Singh, N., Bauland, F., Köppl, D., Gaudl, A., Geistanger, A., Ceglarek, U., Rauh, M., & Taibon, J. (2026) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm-2025-1155 · Cited by 1 · see citing works
“Other conditions (e.g., Klinefelter syndrome, Turner syndrome) can also disrupt urogenital development and have far more wide-ranging e ff ects [7, 15, 16].”
Datar, Y., Madhani, A., & Yin, K. (2026) · Cardiology in the Young · doi:10.1017/s1047951126111949 · Cited by 1 · see citing works
González-Rodríguez, M. T. A., Brukman‐Jiménez, S. A., Cuero‐Quezada, I., Corona‐Rivera, J. R., Corona‐Rivera, A., Serafín‐Saucedo, G., Aguirre-Salas, L. M., & Bobadilla‐Morales, L. (2023) · Genes · doi:10.3390/genes14020253 · Cited by 1 · see citing works
“Chromosomal mosaicism in TS is considered a potential modifier of the phenotype, differing unpredictably between the same individual [2,33,34].”
BackgroundInfluentialSu, W., Sun, L., Li, Z., Liu, X., Zhang, L., Zhao, X., Fan, S.-M., Li, B., Xie, Y., Xiao, W., et al. (2024) · BMC Pediatrics · doi:10.1186/s12887-024-04783-2 · Cited by 1 · see citing works
“Turner syndrome (TS), characterized by short stature and gonadal dysplasia, is the most prevalent sex chromosome abnormality in women, with an incidence of 1/2000– 3000 live female births [1–3].”
BackgroundTurner syndrome: fertility, familial clustering, and cancer risk
Allen‐Brady, K., Verrilli, L. E., Austin, B., Letourneau, J. M., Johnstone, E. B., & Welt, C. K. (2024) · Human Reproduction · doi:10.1093/humrep/deae266 · Cited by 1 · see citing works
Exploring the experiences of adult patients with turner syndrome at a multidisciplinary clinic
Shin, S., Liang, L., Korenvain, C., McCarthy, L. M., & Lega, I. C. (2025) · Maturitas · doi:10.1016/j.maturitas.2025.108214 · Cited by 1 · see citing works
Turner syndrome: the promise of fertility via stem cell technology
Szeliga, A., Malcher, A., Niwczyk, O., Olszewska, M., Kurpisz, M. K., Męczekalski, B., & Adashi, E. Y. (2025) · HORMONES · doi:10.1007/s42000-025-00647-1 · Cited by 1 · see citing works
“Finally, ovarian function is also affected, leading to primary ovarian insufficiency and causing hypergonadotropic hypogonadism [5, 16].”
Special Populations Including Transgender and Questioning Youth
Greydanus, D. E., & Patel, D. R. (2025) · Springer eBooks · doi:10.1007/978-3-031-85784-3_9 · Cited by 1 · see citing works
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“13,14 6 Conversely, low”
Case 27-2023: A 53-Year-Old Woman with Celiac Disease and Upper Gastrointestinal Bleeding
Hashemi, N., Lopes, E. W., Dhami, R. S., Lin, A. E., & Moodley, J. (2023) · New England Journal of Medicine · doi:10.1056/nejmcpc2300903 · Cited by 1 · see citing works
Спорные вопросы хирургического лечения болезни Грейвса
Цуркан, А. Ю., Vanushko, V. E., & Beltsevich, D. G. (2009) · CyberLeninK (CyberLeninka)
Noeth, M., Kemp, T., & Botha, T. (2023) · Journal of Endocrinology Metabolism and Diabetes of South Africa · doi:10.1080/16089677.2023.2198349
“Theories include second-hit insult and more genetic modifications that affect the phenotype.(26)”
BackgroundReduced effects of social feedback on learning in Turner syndrome
Avdic, H. B., Strannegård, C., Engberg, H., Willfors, C., Nordgren, I., Frisén, L., Hirschberg, A. L., Guath, M., Nordgren, A., & Kleberg, J. L. (2023) · Scientific Reports · doi:10.1038/s41598-023-42628-7
Identificação de variantes genéticas associadas com a perda gestacional
Vidal, S. V. P., Santos, T. T., Diniz, P. A., Silva, L. C., dos Santos, A. M. G., Souza, A. D. J., Ventura, S. D. S., Avelar, L. G. A., & Martins, A. A. S. (2023) · Brazilian Journal of Implantology and Health Sciences · doi:10.36557/2674-8169.2023v5n5p309-328
Wang, Y., Zhuang, Z., Xun, Y., Zhao, Y., Shi, M., Mo, X., & Qi, J. (2023) · Research Square · doi:10.21203/rs.3.rs-3463536/v1
Progressive Oestrogen Deficiency in a Young Woman with 45X/46XX Mosaicism: A Case Report
(2023) · Medicine & health · doi:10.17576/mh.2023.1802.24
Immunological Underpinnings of Autoimmune Primary Ovarian Insufficiency
Brodeur, T. Y., & Esfandiari, N. (2024) · Current Obstetrics and Gynecology Reports · doi:10.1007/s13669-024-00376-z
“TS is associated with ovarian dysgenesis and POI that may lead to primary or secondary amenorrhea due to accelerated loss of oocytes [16, 17].”
- Authors
- Gravholt, C. H., Viuff, M., Just, J., Sandahl, K., Brun, S., van der Velden, J., Andersen, N. H., & Skakkebaek, A.
- Affiliations
- Aarhus University Hospital (DK)
- Department of Pediatrics, Radboud University Medical Centre, Amalia Children’s Hospital , 6525 Nijmegen , the Netherlands
- Aalborg University Hospital (DK)
- Corresponding author
- Gravholt, Claus H
- ORCID
- Venue
- Endocrine Reviews
- Publisher
- The Endocrine Society
- Published
- 2022-06-13
- Volume
- 44
- Issue
- 1
- Pages
- 33-69
- ISSN
- 0163-769X (ISSN-L)
- 1945-7189
- OpenAlex
- W4282821954
- Cited by
- 149
- References
- 426
- Citations by year
- 2026: 25 · 2025: 48 · 2024: 41 · 2023: 32 · 2022: 2
- FWCI
- 4.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Endocrine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Funders
- Novo Nordisk Foundation (NNF15OC0016474, NNF20OC0060610)
- Familien Hede Nielsen Foundation
- Independent Research Fund (0134-00406A, 0134-00130B)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic and Clinical Aspects of Sex Determination and Chromosomal Abnormalities
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
- Life Sciences › Immunology and Microbiology › Immunology › Immunodeficiency and Autoimmune Disorders
- Keywords
- Turner syndrome, 45,X, short stature, ovarian dysgenesis, infertility, delayed puberty, congenital malformations, autoimmune disease, type 2 diabetes, neurocognitive impairment, morbidity and mortality, multidisciplinary care, genome organization, candidate genes, transcriptome, epigenome
- MeSH terms
- Diabetes Mellitus, Type 2, Endocrine System Diseases, Female, Humans, Infertility, Turner Syndrome
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