Turner syndrome secondary prevention

There are no established measures for the secondary prevention of Turner Syndrome. Secondary prevention is aimed at preventing complications of Turner syndrome. This involves frequent screening of complications.

• There are no established measures for the secondary prevention of Turner Syndrome. Secondary prevention is aimed at preventing complications of Turner syndrome.
• Echocardiography for cardiac structural abnormalities especially aortic dilation that predisposes the individual to aortic dissection and sudden cardiac death.
  • The aortic severity index is a useful prognostic indicator when assessing for the risk of aortic dilatation. ^[1]
  • It is the aortic diameter corrected for body surface area and a score of more than 2.3 cm per metre square indicates a high risk of aortic dissection (2-2.3 cm per metre square is considered as moderate risk).
  • The advice offered to moderate risk patients is restriction of activities and that offered to high risk patients is that they should completely avoid competitive sports and intensive weight training.
• Renal ultrasound for structural abnormalities like duplication of the collecting system and horseshoe shaped kidney.
• Dual energy x-ray absorptiometry (DEXA) scans may be done to test bone mineral density.
• Audiology for sensorineural and conductive hearing loss.
• Multidisciplinary neuropsychiatric evaluation should be done at major transitional stages such as preschool entry and high school entry. ^[2]
• ECGs should be performed as long QT syndrome frequently occurs secondary to medication used to treat complications of Turner syndrome.
• Individuals with a Y karyotypic abnormality should be screened with fluorescent insitu hybridization and polymerase chain reaction techniques, to detect the risk of developing a gonadoblastoma.
• Laboratory investigations that may help in screening include: ^[3]
  1. Serum gonadotrophins and anti Mullerian hormone– ovarian reserve.
  2. Renal function tests – renal failure secondary to structural abnormalities.
  3. Thyroid function tests – thyroiditis, [hypothyroidism]], hyperthyroidism
  4. Liver function tests – focal nodular hyperplasia
  5. Serum IgA, IgA anti endomysium antibodies and IgA antigliadin antibodies – Celiac disease
  6. Lipid profile – hyperlipidemia
  7. Oral glucose tolerance test and serum glycosylated hemoglobin – for type 2 diabetes mellitus.
  8. Serum 25-hydroxyvitamin D– Vitamin D deficiency.

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