A dose‐response study of hormone replacement in young hypogonadal women: effects on intima media thickness and metabolism

Objective: Turner's syndrome (TS) is a rare genetic disorder caused by complete or partial X chromosome monosomy in a phenotypic female, and it is associated with increased morbidity and mortality for cardiovascular diseases, impaired glucose tolerance, and dyslipidemia. Subjects and methods: In 30 adult TS patients under chronic hormonal replacement therapy (HRT), 17b-estradiol (E 2 ), body mass index (BMI), waist circumference, fasting glucose and insulin, homeostatic model assessment (HOMA) index, serum lipids, oral glucose tolerance test (OGTT), 24 h ambulatory blood pressure monitoring (ABPM), and intima-media thickness (IMT) were evaluated and compared with those in 30 age-and sex-matched controls (CS). Results: No difference was found between TS and CS in E 2 and BMI, whereas waist circumference was higher (P!0.05) in TS (77.7G2.5 cm) than in CS (69.8G1.0 cm). Fasting glucose in TS and in CS was similar, whereas fasting insulin, HOMA index, and 2 h glucose after OGTT were higher (P!0.0005) in TS (13.2G0.8 mUI/l, 2.5G0.2, and 108.9G5.5 mg/dl respectively) than in CS (9.1G0.5 mUI/l, 1.8G0.1, and 94.5G3.8 mg/dl respectively). Total cholesterol was higher (P!0.05) in TS (199.4G6.6 mg/dl) than in CS (173.9G4.6 mg/dl), whereas no significant differences in highdensity lipoprotein, low-density lipoprotein, and triglycerides were found between the two groups. In 13% of TS, ABPM showed arterial hypertension, whereas IMT was !0.9 mm in all TS and CS. A negative correlation between insulin levels, HOMA index, or 2 h glucose after OGTT and E 2 was present in TS. Conclusions: Our results indicate that adult patients with TS under HRT are connoted by higher frequency of central obesity, insulin resistance, hypercholesterolemia, and hypertension.

Section: Discussioncontrasting

confidence: 56%

Metabolic and cardiovascular outcomes in a group of adult patients with Turner's syndrome under hormonal replacement therapy

Giordano¹,

Forno²,

Lanfranco³

et al. 2011

“…Again, our finding of no significant change in VLDL-TG oxidation supports the notion that E 2 affects lipid metabolism via slow pathways, both in the liver and in peripheral tissues. We chose a dose of 4 mg of E 2 in order to make sure that we would achieve premenopausal circulating levels of serum E 2 in the pre-menopausal range, which is often not achieved with lower doses (1-2 mg) of E 2 often used in the typical postmenopausal setting (24,25). A limitation to the study is the possible type 2 statistical error due to the low number of subjects.…”

Section: Discussionmentioning

confidence: 99%

Acute estrogen exposure does not affect basal very low-density lipoprotein–triglyceride production or oxidation in postmenopausal women

Gormsen¹,

Høst²,

Hjerrild³

et al. 2010

Context: Long-term hormone replacement therapy (HRT) with estradiol (E 2 ) is associated with an altered lipid profile including unfavorable increases in triglyceride (TG) concentrations and augmented hepatic very low-density lipoprotein (VLDL)-TG production. There are indications that this effect of estrogens may be immediate. Objective: To study the in vivo effect of a single dose of E 2 on VLDL-TG kinetics and oxidation in humans. Methods: Eight healthy, postmenopausal women were given a single dose of either placebo or E 2 (4 mg) orally. VLDL-TG kinetics was assessed by a 240-min primed-continuous infusion of ex vivo labeled [1-14 C]triolein-labeled VLDL. Fractional and absolute VLDL-TG oxidation was determined by hyamin trapping of exhaled 14 C label. Indirect calorimetry provided measurements of lipid oxidation. Results: Administration of 4 mg of E 2 orally rapidly increased plasma E 2 concentrations from below detection threshold to premenopausal levels. Free fatty acids (FFA) and TG concentrations were unaltered. No immediate effect was observed on either VLDL-TG production (placebo versus E 2 ): 20.0G12.4 vs 24.1G10.7 mmol/min, PZ0.33; VLDL-TG oxidation: 12.3G10.9 vs 12.6 G5.6 mmol/min, PZ0.93); or VLDL-TG clearance rates: 51.4G16.8 vs 64.9G28.8 ml/min, PZ0.34). Conclusions: Short-term E 2 elevation does not affect VLDL-TG production, oxidation, or clearance in humans. We therefore propose that HRT-associated dyslipidemia has a gradual rather than immediate onset.

“…Table 3 presents the age of induction, route, dose and consequences of HRT in TS on the basis of the analysed articles (58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75).…”

Section: Puberty Induction Hrt and Fertility Prospectsmentioning

confidence: 99%

TRANSITION IN ENDOCRINOLOGY: Treatment of Turner's syndrome during transition

Gawlik

Małecka-Tendera

2014

Transition in health care for young patients with Turner's syndrome (TS) should be perceived as a staged but uninterrupted process starting in adolescence and moving into adulthood. As a condition associated with high risk of short stature, cardiovascular diseases, ovarian failure, hearing loss and hypothyroidism, TS requires the attention of a multidisciplinary team. In this review paper, we systematically searched the relevant literature from the last decade to discuss the array of problems faced by TS patients and to outline their optimal management during the time of transfer to adult service. The literature search identified 233 potentially relevant articles of which 114 were analysed. The analysis confirmed that all medical problems present during childhood should also be followed in adult life. Additionally, screening for hypertension, diabetes mellitus, dyslipidaemia, and osteoporosis is needed. After discharge from the paediatric clinic, there is still a long way to go.