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Glucose metabolism, lipid metabolism, and cardiovascular risk factors in adult Turner's syndrome. The impact of sex hormone replacement
Abstract
OBJECTIVE: To examine glucose metabolism, blood pressure, physical fitness, and lipid metabolism in adult untreated women with Turner's syndrome compared with a group of normal women and to examine the effects of female sex hormone substitution on these factors. RESEARCH DESIGN AND METHODS: A total of 26 patients with Turner's syndrome were examined before and during sex hormone replacement with 17 beta-estradiol and norethisterone, and an age-matched control group (n = 24) was examined once. A frequently sampled intravenous glucose tolerance test was applied with minimal model assessment. We also performed an oral glucose tolerance test, measurement of 24-h ambulatory blood pressure, and assessment of physical fitness and lipid metabolism. RESULTS: Insulin sensitivity (SI) and glucose effectiveness (SG) were similar in Turner's syndrome patients and control subjects, whereas the acute insulin response (P = 0.03) was lower in Turner's syndrome patients, and no change was seen during sex hormone treatment. Abnormal glucose tolerance was found in 50% of Turner's syndrome patients before and 78% during treatment with sex hormones. Fat-free mass (FFM; P = 0.0005) and physical fitness (P = 0.002) were lower in Turner's syndrome subjects compared with control subjects. During treatment, an increase in FFM (P = 0.001) and physical fitness (P = 0.02) was seen in Turner's syndrome patients. Blood pressure was increased in Turner's syndrome, and a decrease was seen in diastolic blood pressure during treatment with sex hormones. CONCLUSIONS: Turner's syndrome is associated with glucose intolerance, diminished first-phase insulin response, elevated blood pressure, reduced FFM, and physical fitness. Sex hormone administration causes a deterioration in glucose tolerance, increases FFM and physical fitness, and has beneficial effects on blood pressure. The deleterious effect on glucose tolerance may be mediated by norethisterone, a gestagen known to have androgenic effects.
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“Another study showed that blood pressure decreased during treatment with E2 (either oral or TD) for 6 months compared with no treatment for 4 months.357”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [357]
In the citing paper
“The prevalence of hypertension is as high as 20%-40% in children441,453 and up to 60% in adults with TS.357,452,454-456”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [357]
In the citing paper
“Individuals with TS are at an increased risk for both type 1 and type 2 diabetes.29,222,227,357,384,706”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [357]
In the citing paper
“The available literature shows that girls and women with TS do not meet current general recommendations for physical activity,357,455,496-498 which is concerning because less physical activity has been associated with excess weight gain and hypertension in adults with TS.”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [357]
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Metadata
- Authors
- Gravholt, C. H., Naeraa, R. W., Nyholm, B., Gerdes, L. U., Christiansen, E., Schmitz, O., & Christiansen, J. S.
- Affiliations
- Aarhus University Hospital (DK)
- Paediatric Department A, University Hospital of Aarhus Aarhus, Denmark
- Steno Diabetes Center Gentofte, Denmark
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 1998-07-01
- Volume
- 21
- Issue
- 7
- Pages
- 1062-1070
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2016362474
- Cited by
- 204
- References
- 0
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 7 · 2023: 6 · 2022: 5 · 2021: 6 · 2020: 9 · 2019: 11 · 2018: 12 · 2017: 7 · 2016: 2 · 2015: 7 · 2014: 5 · 2013: 9 · 2012: 5
- FWCI
- 3.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Aarhus Universitet
- Novo Nordisk
- Diabetesforeningen
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic and Clinical Aspects of Sex Determination and Chromosomal Abnormalities
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Sexual Differentiation and Disorders
- Keywords
- Turner syndrome, sex hormone replacement therapy, estradiol, norethisterone, impaired glucose tolerance, insulin sensitivity, insulin resistance, insulin response, blood pressure, physical fitness, fat-free mass, lipid metabolism, cardiovascular risk factors
- MeSH terms
- Administration, Oral, Adult, Blood Glucose, Body Composition, Cardiovascular Diseases, Estradiol, Female, Glucose, Glucose Tolerance Test, Humans, Injections, Intravenous, Insulin, Insulin Resistance, Lipids, Models, Biological, Oxygen Consumption, Risk Factors, Turner Syndrome, Estrogen Replacement Therapy, Blood Pressure Monitoring, Ambulatory, Area Under Curve, Lipid Metabolism
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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