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American Journal of Cardiovascular Drugs
Published in: American Journal of Cardiovascular Drugs 6/2002

01-11-2002 | Review Article

Turner Syndrome and the Heart

Cardiovascular Complications and Treatment Strategies

Author: Dr Claus Højbjerg Gravholt

Published in: American Journal of Cardiovascular Drugs | Issue 6/2002

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Abstract

Turner syndrome is a condition usually associated with reduced final height, gonadal dysgenesis, and thus insufficient circulating levels of female sex steroids, and infertility. A number of other signs and symptoms are seen more frequently with the syndrome. With respect to cardiac function, congenital malformations of the heart and the great vessels, hypertension and ischemic heart disease, and increased risk of aortic dissection are all conditions that the pediatrician or the physician caring for females with Turner syndrome should keep in mind. Many girls and adolescents with Turner syndrome receive growth hormone (GH) treatment, which has so far been an effective and well-tolerated therapy. Nevertheless, because of the experience from acromegaly, the physician should monitor blood pressure and perform echocardiography, together with clinical examinations by a cardiologist at regular intervals. During adulthood most women with Turner syndrome are faced with premature menopause and the need for female hormone replacement therapy (HRT). During clinical evaluation of girls and women with Turner syndrome, these conditions and complications should be kept under surveillance.
Here the cardiovascular complications of Turner syndrome are reviewed. The risk of congenital heart defects such as bicuspid aortic valves, aortic coarctation, other valve abnormalities, and septal defect is increased. Likewise, the risk of aortic dissection at a young age is increased, as is the risk of hypertension, ischemic heart disease, and stroke. GH therapy does not seem to adversely affect the heart, although longer-term follow-up studies are needed. In short-term studies, HRT lowers blood pressure, while any effect on the risk of ischemic heart disease has not been evaluated. Treatment with GH and HRT are discussed in relation to the heart and great vessels. Presently, the pathophysiology of the congenital cardiovascular malformation in Turner syndrome is unexplained, although different theories exist. Recommendations for clinical practice are given, including life-long surveillance of cardiac function, aortic diameter and blood pressure.
Literature
1.
Turner HH. A syndrome of infantilism, congenital webbed neck, and cubitus valgus. Endocrinology 1938; 23: 566–74CrossRef
2.
Lippe B. Turner syndrome. Endocrinol Metab Clin North Am 1991; 20: 121–52PubMed
3.
Sylven L, Hagenfeldt K, Brondum NK, et al. Middle-aged women with Turner’s syndrome: medical status, hormonal treatment and social life. Acta Endocrinol 1991;125:359–65PubMed
4.
Gotzsche CO, Krag-Olsen B, Nielsen J, et al. Prevalence of cardiovascular malformations and association with karyotypes in Turner’s syndrome. Arch Dis Child 1994;71:433–6PubMedCrossRef
5.
Gravholt CH, Juul S, Naeraa RW, et al. Morbidity in Turner syndrome. J Clin Epidemiol 1998; 51: 147–58PubMedCrossRef
6.
Elsheikh M, Casadei B, Conway GS, et al. Hypertension is a major risk factor for aortic root dilatation in women with Turner’s syndrome. Clin Endocrinol (Oxf) 2001;54:69–73CrossRef
7.
Jacobs PA, Melville M, Ratcliffe S, et al. A cytogenetic survey of 11 680 newborn infants. Ann Hum Genet 1974; 37: 359–76PubMedCrossRef
8.
Hook EB, Warburton D. The distribution of chromosomal genotypes associated with Turner’s syndrome: livebirth prevalence rates and evidence for diminished fetal mortality and severity in genotypes associated with structural X abnormalities or mosaicism. Hum Genet 1983; 64: 24–7PubMedCrossRef
9.
Nielsen J, Wohlert M. Chromosome abnormalities found among 34,910 newborn children: results from a 13-year incidence study in Arhus, Denmark. Hum Genet 1991; 87: 81–3PubMedCrossRef
10.
Imaizumi K, Kuroki Y. Prevalence of Turner syndrome in Japan. Int Symposium on Turner Syndrome: 1992; Japan, 3-6
11.
Savendahl L, Davenport ML. Delayed diagnoses of Turner’s syndrome: proposed guidelines for change. J Pediatr 2000; 137: 455–9PubMedCrossRef
12.
Sas TC, Muinck Keizer-Schrama SM, Stijnen T, et al. Normalization of height in girls with Turner syndrome after long-term growth hormone treatment: results of a randomized dose-response trial. J Clin Endocrinol Metab 1999; 84: 4607–12PubMedCrossRef
13.
Haddad HM, Wilkins L. Congenital anomalies associated with gonadal aplasia: review of 55 cases. Pediatrics 1959; 23: 885–902PubMed
14.
Lemli L, Smith DW. The XO syndrome: a study of the differentiated phenotype in 25 patients. J Pediatr 1963; 63: 577–88PubMedCrossRef
15.
Nora JJ, Torres FG, Sinha AK, et al. Characteristic cardiovascular anomalies of XO Turner syndrome, XX and XY phenotype and XO-XX Turner mosaic. Am J Cardiol 1970; 25: 639–41PubMedCrossRef
16.
Rainier-Pope CR, Cummingham RD, Nadas AS, et al. Cardiovascular malformations in Turner’s syndrome. Pediatrics 1964; 19: 919–25
17.
Mutinelli MR, Nizzoli G, Chiumello G, et al. Echocardiographic diagnosis of congenital bicuspid aortic valves in gonadal dysgenesis. G Ital Cardiol 1986; 16: 496–8PubMed
18.
Dawson-Falk KL, Wright AM, Bakker B, et al. Cardiovascular evaluation in Turner syndrome: utility of MR imaging. Australas Radiol 1992; 36: 204–9PubMedCrossRef
19.
Berdahl LD, Wenstrom KD, Hanson JW. Web neck anomaly and its association with congenital heart disease. Am J Med Genet 1995; 56: 304–7PubMedCrossRef
20.
Lacro RV, Jones KL, Benirschke K. Coarctation of the aorta in Turner syndrome: a pathologic study of fetuses with nuchal cystic hygromas, hydrops fetalis, and female genitalia. Pediatrics 1988; 81: 445–51PubMed
21.
Clark EB. Neck web and congenital heart defects: a pathogenic association in 45 X-O Turner syndrome? Teratology 1984; 29: 355–61PubMedCrossRef
22.
Miller MJ, Geffner ME, Lippe BM, et al. Echocardiography reveals a high incidence of bicuspid aortic valve in Turner syndrome. J Pediatr 1983; 102: 47–50PubMedCrossRef
23.
Sybert VP. Cardiovascular malformations and complications in Turner syndrome. Pediatrics 1998; 101(1): E11PubMedCrossRef
24.
Mazzanti L, Cacciari E. Congenital heart disease in patients with Turner’s syndrome. Italian Study Group for Turner Syndrome (ISGTS). J Pediatr 1998; 133: 688–92PubMedCrossRef
25.
Mazzanti L, Prandstraller D, Tassinari D, et al. Heart disease in Turner’s syndrome. Helv Paediatr Acta 1988; 43: 25–31PubMed
26.
Lin AE, Lippe B, Rosenfeld RG. Further delineation of aortic dilation, dissection, and rupture in patients with turner syndrome. Pediatrics 1998; 102(1): e12PubMedCrossRef
27.
Larson EW, Edwards WD. Risk factors for aortic dissection: a necropsy study of 161 cases. Am J Cardiol 1984; 53: 849–55PubMedCrossRef
28.
Natowicz M, Chatten J, Clancy R, et al. Genetic disorders and major extracardiac anomalies associated with the hypoplastic left heart syndrome. Pediatrics 1988; 82: 698–706PubMed
29.
Greenlee R, Hoyme H, Witte M, et al. Developmental disorders of the lymphatic system. Lymphology 1993; 26: 156–68PubMed
30.
Barr Jr M, Oman-Ganes L. Turner syndrome morphology and morphometrics: cardiac hypoplasia as a cause of midgestation death. Teratology 2002; 66: 65–72PubMedCrossRef
31.
Carrel L, Cottle AA, Goglin KC, et al. A first-generation X-inactivation profile of the human X chromosome. Proc Natl Acad Sci U S A 1999; 96: 14440–4PubMedCrossRef
32.
Rao E, Weiss B, Fukami M, et al. Pseudoautosomal deletions encompassing a novel homeobox gene cause growth failure in idiopathic short stature and Turner syndrome. Nat Genet 1997; 16: 54–63PubMedCrossRef
33.
Ellison JW, Wardak Z, Young MF, et al. PHOG, a candidate gene for involvement in the short stature of Turner syndrome. Hum Mol Genet 1997; 6: 1341–7PubMedCrossRef
34.
Fang J, Dagenais SL, Erickson RP, et al. Mutations in FOXC2 (MFH-1), a forkhead family transcription factor, are responsible for the hereditary lymphedema-distichiasis syndrome. Am J Hum Genet 2000; 67: 1382–8PubMedCrossRef
35.
Ogata T, Muroya K, Matsuo N, et al. Turner syndrome and Xp deletions: clinical and molecular studies in 47 patients. J Clin Endocrinol Metab 2001; 86: 5498–508PubMedCrossRef
36.
Nathwani NC, Unwin R, Brook CG, et al. Blood pressure and Turner syndrome. Clin Endocrinol (Oxf) 2000; 52: 363–70CrossRef
37.
Gravholt CH, Naeraa RW, Nyholm B, et al. Glucose metabolism, lipid metabolism, and cardiovascular risk factors in adult Turner syndrome: the impact of sex hormone replacement. Diabetes Care 1998; 21: 1062–70PubMedCrossRef
38.
Verdecchia P, Schillaci G, Gatteschi C, et al. Blunted nocturnal fall in blood pressure in hypertensive women with future cardiovascular morbid events. Circulation 1993; 88: 986–92PubMedCrossRef
39.
Verdecchia P, Schillaci G, Boldrini F, et al. Sex, cardiac hypertrophy and diurnal blood pressure variations in essential hypertension. J Hypertens 1992; 10: 683–92PubMedCrossRef
40.
Verdecchia P, Schillaci G, Guerrieri M, et al. Orcadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation 1990; 81: 528–36PubMedCrossRef
41.
Ross JL, Feuillan P, Long LM, et al. Lipid abnormalities in Turner syndrome. J Pediatr 1995; 126: 242–5PubMedCrossRef
42.
Gravholt CH, Klausen IC, Weeke J, et al. Lp(a) and lipids in adult Turner’s syndrome: impact of treatment with 17beta-estradiol and norethisterone. Atherosclerosis 2000; 150: 201–8PubMedCrossRef
43.
Dean JW, Fowler PB. Exaggerated responsiveness to thyrotrophin releasing hormone: a risk factor in women with coronary artery disease. BMJ 1985; 290: 1555–61PubMedCrossRef
44.
Arem R, Patsch W. Lipoprotein and apolipoprotein levels in subclinical hypothyroidism: effect of levothyroxine therapy. Arch Intern Med 1990; 150: 2097–100PubMedCrossRef
45.
Ivarsson SA, Ericsson UB, Nilsson KO, et al. Thyroid autoantibodies, Turner’s syndrome and growth hormone therapy. Acta Paediatr 1995; 84: 63–5PubMedCrossRef
46.
Van Campenhout J, Antaki A, Rasio E. Diabetes mellitus and thyroid autoimmunity in gonadal dysgenesis. Fertil Steril 1973; 24: 1–9PubMed
47.
48.
Pai GS, Leach DC, Weiss L, et al. Thyroid abnormalities in 20 children with Turner syndrome. J Pediatr 1977; 91: 267–9PubMedCrossRef
49.
Bright GM, Blizzard RM, Kaiser DL, et al. Organ-specific autoantibodies in children with common endocrine diseases. J Pediatr 1982; 100: 8–14PubMedCrossRef
50.
Germain EL, Plotnick LP. Age-related anti-thyroid antibodies and thyroid abnormalities in Turner syndrome. Acta Paediatr Scand 1986; 75: 750–5PubMedCrossRef
51.
Fleming S, Cowell C, Bailey J, et al. Hashimoto’s disease in Turner’s syndrome. Clin Invest Med 1988; 11: 243–6PubMed
52.
Gruneiro PL, Iorcansky S, Coco R, et al. High incidence of thyroid disturbances in 49 children with Turner syndrome. J Pediatr 1987; 111: 258–61CrossRef
53.
Radetti G, Mazzanti L, Paganini C, et al. Frequency, clinical and laboratory features of thyroiditis in girls with Turner’s syndrome. The Italian Study Group for Turner’s Syndrome. Acta Paediatr 1995; 84: 909–12PubMedCrossRef
54.
Marner B, Bille G, Christy M, et al. Islet cell cytoplasmic antibodies (ICA) in diabetes and disorders of glucose tolerance. Diabet Med 1991; 8: 812–6PubMedCrossRef
55.
Emans SJ, Grace E, Hoffer FA, et al. Estrogen deficiency in adolescents and young adults: impact on bone mineral content and effects of estrogen replacement therapy. Obstet Gynecol 1990; 76: 585–92PubMed
56.
Larizza D, Martinetti Bianchi M, et al. Autoimmunity, HLA, Gm and Km polymorphisms in Turner’s syndrome. Autoimmunity 1989; 4: 69–78PubMedCrossRef
57.
Chiovato L, Larizza D, Bendinelli G, et al. Autoimmune hypothyroidism and hyperthyroidism in patients with Turner’s syndrome. Eur J Endocrinol 1996; 134: 568–75PubMedCrossRef
58.
Elsheikh M, Wass JA, Conway GS. Autoimmune thyroid syndrome in women with Turner’s syndrome-the association with karyotype. Clin Endocrinol (Oxf) 2001; 55: 223–6CrossRef
59.
Jeresaty RM, Basu SK, Franco J. Dissecting aneurysm of the aorta in Turner’s syndrome. JAMA 1972; 222: 574–6PubMedCrossRef
60.
Strader III WJ, Wachtel HL, Lundberg Jr GD. Hypertension and aortic rupture in gonadal dysgenesis. J Pediatr 1971; 79: 473–5PubMedCrossRef
61.
Youker JE, Roe BB. Aneurysm of the aortic sinuses and ascending aorta in Turner’s syndrome. Am J Cardiol 1969; 23: 89–93PubMedCrossRef
62.
Cecchi F, Samoun M, Santoro G, et al. Chronic dissecting aortic aneurysm and Turner’s syndrome: apropos of a case. Arch Mal Coeur Vaiss 1992; 85: 1043–6PubMed
63.
Kusaba E, Imada T, Iwakuma A, et al. Aortic aneurysm complicated with coarctation of the aorta and Turner syndrome. Kyobu Geka 1995; 48: 1115–7PubMed
64.
Ota Y, Tsunemoto M, Shimada M, et al. Aortic dissection associated with Turner’s syndrome. Kyobu Geka 1992; 45: 411–4PubMed
65.
Oohara K, Yamazaki T, Sakaguchi K, et al. Acute aortic dissection, aortic insufficiency, and a single coronary artery in a patient with Turner’s syndrome. J Cardiovasc Surg (Torino) 1995; 36: 273–5
66.
Imamura M, Aoki H, Eya K, et al. Balloon angioplasty before Wheat’s operation in a patient with Turner’s syndrome. Cardiovasc Surg 1995; 3: 70–2PubMedCrossRef
67.
68.
69.
Slater DN, Grundman MJ, Mitchell L. Turner’s syndrome associated with bicuspid aortic stenosis and dissecting aortic aneurysm. Postgrad Med J 1982; 58: 436–8PubMedCrossRef
70.
Kostich ND, Opitz JM. Ullrich-Turner syndrome associated with cystic medial necrosis of the aorta and great vessels. Am J Med 1965; 38: 943–9PubMedCrossRef
71.
Edwards WD, Leaf DS, Edwards JE. Dissecting aortic aneurysm associated with congenital bicuspid aortic valve. Circulation 1978; 57: 1022–5PubMedCrossRef
72.
Asch AJ. Turner’s syndrome occurring with Horner’s syndrome: seen with coarctation of the aorta and aortic aneurysm. Am J Dis Child 1979; 133: 827–30PubMed
73.
Ravelo HR, Stephenson LW, Friedman S, et al. Coarctation resection in children with Turner’s syndrome: a note of caution. J Thorac Cardiovasc Surg 1980; 80: 427–30PubMed
74.
Kido G, Miyagi A, Shibuya T, et al. Turner’s syndrome with pituitary hyperplasia: a case report. No Shinkei Geka 1994; 22: 333–8PubMed
75.
Rubin K. Aortic dissection and rupture in Turner syndrome [letter]. J Pediatr 1993; 122: 670PubMed
76.
Ohuchi H, Kawazoe K, Kosakai Y, et al. One-staged repair for coarctation of the aorta and annuloaortic ectasia with severe aortic regurgitation in a patient with Turner syndrome. Nippon Kyobu Geka Gakkai Zasshi 1992; 40: 2247–51PubMed
77.
Pollak H, Veit F, Enenkel W. Presumed “successful” fibrinolysis in unrecognized acute aortic dissection. Dtsch Med Wochenschr 1992; 117: 368–71PubMedCrossRef
78.
Martin MM, Beekman RH, Rocchini AP, et al. Aortic aneurysms after subclavian angioplasty repair of coarctation of the aorta. Am J Cardiol 1988; 61: 951–3PubMedCrossRef
79.
Bartlema KA, Hogervorst M, Akkersdijk GJ, et al. Isolated abdominal aortic dissection in a patient with Turner’s syndrome [letter]. Surgery 1995; 117: 116–7PubMedCrossRef
80.
Apostolopoulos T, Kyriakidis M, Toutouzas P. Endarteritis of the aortic arch in Turner’s syndrome with cystic degeneration of the aorta. Int J Cardiol 1992; 35: 417–9PubMedCrossRef
81.
Allemann J, Muller G, Legat M. Rare variant of a Turner-Ullrich syndrome. Schweiz Med Wochenschr 1982; 112: 1249–55PubMed
82.
Buheitel G, Singer H, Hofbeck M. Aortic aneurysms in Ullrich-Turner syndrome. Klin Padiatr 1996; 208: 42–5PubMedCrossRef
83.
Akimoto N, Shimizu T, Ishikawa M, et al. The surgical treatment of aortic dissection in a patient with Turner’s syndrome: report of a case. Surg Today 1994; 24: 929–32PubMedCrossRef
84.
Meunier JP, Jazayeri S, David M. Acute type A aortic dissection in an adult patient with Turner’s syndrome. Heart 2001; 86(5): 546PubMedCrossRef
85.
Anabtawi IN, Ellison RG, Yeh TJ, et al. Dissecting aneurysm of aorta associated with Turner’s syndrome. J Thorac Cardiovasc Surg 1964; 47: 750–4PubMed
86.
87.
Spittell PC, Spittell Jr JA, Joyce JW, et al. Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990). Mayo Clin Proc 1993; 68: 642–51PubMed
88.
Prandstraller D, Mazzanti L, Picchio FM, et al. Turner’s syndrome: cardiologic profile according to the different chromosomal patterns and long-term clinical follow-up of 136 nonpreselected patients. Pediatr Cardiol 1999; 20: 108–12PubMedCrossRef
89.
Nielsen J, Sillesen I, Hansen KB. Fertility in women with Turner’s syndrome: case report and review of literature. Br J Obstet Gynaecol 1979; 86: 833–5PubMedCrossRef
90.
Hovatta O. Pregnancies in women with Turner’s syndrome. Ann Med 1999; 31: 106–10PubMed
91.
Foudila T, Soderstrom AV, Hovatta O. Turner’s syndrome and pregnancies after oocyte donation. Hum Reprod 1999; 14: 532–5PubMedCrossRef
92.
Swapp GH, Johnston AW, Watt JL, et al. A fertile woman with non-mosaic Turner’s syndrome: case report and review of the literature. Br J Obstet Gynaecol 1989; 96: 876–80PubMedCrossRef
93.
Kaneko N, Kawagoe S, Hiroi M. Turner’s syndrome: review of the literature with reference to a successful pregnancy outcome. Gynecol Obstet Invest 1990; 29: 81–7PubMedCrossRef
94.
Birdsall M, Kennedy S. The risk of aortic dissection in women with Turner syndrome [letter]. Hum Reprod 1996; 11: 1587PubMedCrossRef
95.
Nagel TC, Tesch LG. ART and high risk patients [letter]. Fertil Steril 1997; 68: 748–9PubMed
96.
Beauchesne LM, Connolly HM, Ammash NM, et al. Coarctation of the aorta: outcome of pregnancy. J Am Coll Cardiol 2001; 38: 1728–33PubMedCrossRef
97.
Weytjens C, Bove T, Van Der NP. Aortic dissection and Turner’s syndrome. J Cardiovasc Surg (Torino) 2000; 41: 295–7
98.
Ranke MB, Pfluger H, Rosendahl W, et al. Turner syndrome: spontaneous growth in 150 cases and review of the literature. Eur J Pediatr 1983; 141:81–8PubMedCrossRef
99.
Karlberg J, Albertsson WK, Nilsson KO, et al. Growth in infancy and childhood in girls with Turner’s syndrome. Acta Paediatr Scand 1991; 80: 1158–65PubMedCrossRef
100.
Davenport ML, Punyasavatsut N, Gunther D, et al. Turner syndrome: a pattern of early growth failure. Acta Paediatr Suppl 1999; 88: 118–21PubMedCrossRef
101.
Lyon AJ, Preece MA, Grant DB. Growth curve for girls with Turner syndrome. Arch Dis Child 1985; 60: 932–5PubMedCrossRef
102.
Pasquino AM, Passeri F, Pucarelli I, et al. Spontaneous pubertal development in Turner’s syndrome. Italian Study Group for Turner’s Syndrome. J Clin Endocrinol Metab 1997; 82: 1810–3PubMedCrossRef
103.
Massarano AA, Brook CG, Hindmarsh PC, et al. Growth hormone secretion in Turner’s syndrome and influence of oxandrolone and ethinyl oestradiol. Arch Dis Child 1989; 64: 587–92PubMedCrossRef
104.
Reiter JC, Craen M, Van Vliet G. Decreased growth hormone response to growth hormone-releasing hormone in Turner’s syndrome: relation to body weight and adiposity. Acta Endocrinol 1991; 125: 38–42PubMed
105.
Ranke MB, Blum WF, Haug F, et al. Growth hormone, somatomedin levels and growth regulation in Turner’s syndrome. Acta Endocrinol 1987; 116: 305–13PubMed
106.
Saenger P, Schwartz E, Wiedemann E, et al. The interaction of growth hormone, somatomedin and oestrogen in patients with Turner’s syndrome. Acta Endocrinol 1976; 81: 9–18PubMed
107.
Wit JM, Massarano AA, Kamp GA, et al. Growth hormone secretion in patients with Turner’s syndrome as determined by time series analysis. Acta Endocrinol 1992; 127: 7–12PubMed
108.
Hochberg Z, Aviram M, Rubin D, et al. Decreased sensitivity to insulin-like growth factor I in Turner’s syndrome: a study of monocytes and T lymphocytes. Eur J Clin Invest 1997; 27: 543–7PubMedCrossRef
109.
Swearingen B, Barker FG, Katznelson L, et al. Long-term mortality after transsphenoidal surgery and adjunctive therapy for acromegaly. J Clin Endocrinol Metab 1998; 83: 3419–26PubMedCrossRef
110.
Colao A, Cuocolo A, Marzullo P, et al. Is the acromegalic cardiomyopathy reversible? Effect of 5-year normalization of growth hormone and insulin-like growth factor I levels on cardiac performance. J Clin Endocrinol Metab 2001; 86: 1551–7PubMedCrossRef
111.
Caprio S, Boulware SD, Press M, et al. Effect of growth hormone treatment on hyperinsulinemia associated with Turner syndrome. J Pediatr 1992; 120: 238–43PubMedCrossRef
112.
Saenger P, Attie KM, DiMartino Nardi J, et al. Carbohydrate metabolism in children receiving growth hormone for 5 years: chronic renal insufficiency compared with growth hormone deficiency, Turner syndrome, and idiopathic short stature. Genentech Collaborative Group. Pediatr Nephrol 1996; 10: 261–3PubMed
113.
Gravholt CH, Naeraa RW. Reference values for body proportions and body composition in adult women with Turner’s syndrome. Am J Med Genet 1997; 72: 403–8PubMedCrossRef
114.
Bordeleau L, Cwinn A, Turek M, et al. Aortic dissection and Turner’s syndrome: case report and review of the literature. J Emerg Med 1998; 16: 593–6PubMedCrossRef
115.
Sas TC, Cromme-Dijkhuis AH, de Muinck K, et al. The effects of long-term growth hormone treatment on cardiac left ventricular dimensions and blood pressure in girls with Turner’s syndrome. J Pediatr 1999; 135: 470–6PubMedCrossRef
116.
Nathwani NC, Unwin R, Brook CG, et al. The influence of renal and cardiovascular abnormalities on blood pressure in Turner syndrome. Clin Endocrinol (Oxf) 2000; 52: 371–7CrossRef
117.
Sack MN, Rader DJ, Cannon RO. Oestrogen and inhibition of oxidation of lowdensity lipoproteins in postmenopausal women. Lancet 1994; 343: 269–70PubMedCrossRef
118.
Gilligan DM, Quyyumi AA, Cannon RO. Effects of physiological levels of estrogen on coronary vasomotor function in postmenopausal women. Circulation 1994; 89: 2545–51PubMedCrossRef
119.
Losordo DW, Kearney M, Kim EA, et al. Variable expression of the estrogen receptor in normal and atherosclerotic coronary arteries of premenopausal women. Circulation 1994; 89: 1501–10PubMedCrossRef
120.
Selzman CH, Gaynor JS, Turner AS, et al. Ovarian ablation alone promotes aortic intimai hyperplasia and accumulation of fibroblast growth factor. Circulation 1998; 98: 2049–54PubMedCrossRef
121.
Elsheikh M, Bird R, Casadei B, et al. The effect of hormone replacement therapy on cardiovascular hemodynamics in women with Turner’s syndrome. J Clin Endocrinol Metab 2000; 85: 614–8PubMedCrossRef
122.
Seely EW, Walsh BW, Gerhard MD, et al. Estradiol with or without progesterone and ambulatory blood pressure in postmenopausal women. Hypertension 1999; 33: 1190–4PubMedCrossRef
123.
Gravholt CH, Naerra RW, Fisher S, et al. Body composition and physical fitness are major determinants of the growth hormone_IGF axis aberrations in adult Turner syndrome, with important modulations by treatment with 17-Beta-Estradiol. J Clin Endocrinol Metab 1997; 82: 2570–7PubMedCrossRef
124.
Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002; 288: 321-33
125.
Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA 1998; 280: 605–13PubMedCrossRef
126.
Viscoli CM, Brass LM, Kernan WN, et al. A clinical trial of estrogen-replacement therapy after ischemic stroke. N Engl J Med 2001; 345: 1243–9PubMedCrossRef
127.
Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 1988; 37: 1595–607PubMedCrossRef
128.
Naeraa RW, Gravholt CH, Hansen J, et al. Mortality in Turner syndrome. In: Albertsson-Wikland K, Ranke MB, editors. Turner syndrome in a life span perspective: research and clinical aspects. Amsterdam: Elsevier, 1995: 323
129.
Price WH, Clayton JF, Collyer S, et al. Mortality ratios, life expectancy, and causes of death in patients with Turner’s syndrome. J Epidemiol Community Health 1986; 40: 97–102PubMedCrossRef
130.
Swerdlow AJ, Hermon C, Jacobs PA, et al. Mortality and cancer incidence in persons with numerical sex chromosome abnormalities: a cohort study. Ann Hum Genet 2001; 65: 177–88PubMedCrossRef
131.
Saenger P, Wikland KA, Conway GS, et al. Recommendations for the diagnosis and management of Turner syndrome. J Clin Endocrinol Metab 2001; 86: 3061–9PubMedCrossRef
Metadata
Title
Turner Syndrome and the Heart
Cardiovascular Complications and Treatment Strategies
Author
Dr Claus Højbjerg Gravholt
Publication date
01-11-2002
Publisher
Springer International Publishing
Published in
American Journal of Cardiovascular Drugs / Issue 6/2002
Print ISSN: 1175-3277
Electronic ISSN: 1179-187X
DOI
https://doi.org/10.2165/00129784-200202060-00005

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