X-chromosome gene dosage and the risk of diabetes in Turner syndrome
Open accessAbstract
BACKGROUND: Turner syndrome (TS) is caused by the absence or fragmentation of the second sex chromosome. An increased risk of diabetes mellitus (DM) has consistently been noted, but the specific phenotype and genetic etiology of this trait are unknown. METHODS: In a prospective study, we examined the prevalence of DM in adult participants in an intramural National Institutes of Health (NIH) TS study. Results were analyzed with respect to karyotype, age, body mass index (BMI), and autoimmune indices. Insulin sensitivity and secretion were compared in age- and BMI-matched euglycemic women with TS and healthy female controls. We compared gene expression profiles in lymphocytes from differentially affected TS groups. RESULTS: Type 2 DM was present in 56 of 224 (25%) of the women with TS; type 1 DM was found in only one woman (<0.5%). DM was more prevalent among women with an isoXq chromosome compared to X monosomy (40.0 vs. 17.3%; P = 0.004). Euglycemic women with TS (n = 72; age, 33 +/- 12 yr; BMI, 23 +/- 3 kg/m(2)) had significantly higher glycemic and lower insulin responses to OGTT, with insulin sensitivity similar to controls. Gene expression profiles comparing 46,X,i(X)q vs. 45,X groups showed a significant increase in Xq transcripts and in potentially diabetogenic autosomal transcripts in the isoXq group. CONCLUSION: Type 2 DM associated with deficient insulin release is significantly increased among women with monosomy for the X-chromosome but is increased even more among women with monosomy for Xp coupled with trisomy for Xq. These data suggest that haploinsufficiency for unknown Xp genes increases risk for DM and that excess dosage of Xq genes compounds the risk.
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Diabetes mellitus is common in TS, with studies reporting a 25%-70% lifetime prevalence.
“Diabetes mellitus is common in TS, with studies reporting a 25%-70% lifetime prevalence.703-705”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [703]
Genes on Xp related to beta-cell function and insulin signal transduction affect overall glucose metabolism and likely contribute to the risk of diabetes in TS, as illustrated by studies showing individuals with a 45,X karyotype or deletions of Xp to have a much higher incidence of diabetes compared to individuals with deletions isolated to Xq (17%-23% vs 9%).
“Genes on Xp related to beta-cell function and insulin signal transduction affect overall glucose metabolism and likely contribute to the risk of diabetes in TS, as illustrated by studies showing individuals with a 45,X karyotype or deletions of Xp to have a much higher incidence of diabetes compared to individuals with deletions isolated to Xq (17%-23% vs 9%).630,703”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [703]
Some studies have found an association of metabolic abnormalities with monosomy X, ring X, isochromosome Xq, and Xp deletion, however findings are inconsistent and require more data before clinical interpretation.
“Some studies have found an association of metabolic abnormalities with monosomy X, ring X, isochromosome Xq, and Xp deletion, however findings are inconsistent and require more data before clinical interpretation.450,630,697,703”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [703]
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- Authors
- Bakalov, V. K., Cheng, C., Zhou, J., & Bondy, C. A.
- Affiliations
- National Institutes of Health (US)
- Corresponding author
- Bakalov, Vladimir K.
- ORCID
- Zhou, Jian
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2009-09-01
- Volume
- 94
- Issue
- 9
- Pages
- 3289-3296
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC2741724
- OpenAlex
- W2144783013
- Cited by
- 118
- References
- 41
- Citations by year
- 2026: 8 · 2025: 5 · 2024: 8 · 2023: 13 · 2022: 5 · 2021: 8 · 2020: 12 · 2019: 14 · 2018: 6 · 2017: 5 · 2016: 4 · 2015: 5 · 2014: 9 · 2013: 4 · 2012: 6
- FWCI
- 2.34
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- 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 › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- Turner syndrome, diabetes mellitus, type 2 diabetes, insulin secretion, insulin sensitivity, gene expression profiling, lymphocytes, karyotype
- MeSH terms
- Adult, Aged, Diabetes Mellitus, Female, Glucose, Humans, Middle Aged, Risk, Turner Syndrome, Autoimmunity, Prevalence, Glucose Intolerance, Gene Dosage, Gene Expression Profiling, Genes, X-Linked
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