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Home Health Professionals Turner`s Syndrome Management Diagnosis

Diagnosis

The diagnosis of Turner’s syndrome is based upon the presence of characteristic physical features in phenotypic females associated with complete/ partial absence of an X chromosome. Individuals without the characteristic clinical features despite having a 45X karyotype are not considered to have Turner’s syndrome.

The diagnosis should be considered in any female with unexplained growth failure/short stature, pubertal delay, features of the Turner’s syndrome  phenotype (Table 1) or primary or secondary amenorrhoea with elevated FSH levels.

Diagnosis is made on the basis of karyotype (which should include probing for Y chromosome material). The presence of Y chromosome material may lead to the development of gonadoblastoma (reported risk varies from 7% to >30%) and referral for consideration of gonadectomy is warranted.

Table 1: Clinical Features of Turner’s syndrome

Feature
Short stature/ growth retardation

Cardiovascular

  • Bicuspid aortic valve
  • Coarctation of the aorta
  • Aortic dissection
  • Hypertension

Reproductive

  • Spontaneous puberty/ menarche
  • Oestrogen deficiency (primary amenorrhoea or premature menopause)
  • Infertility

Kidney

  • Horseshoe kidney
  • Structural renal tract abnormalities

Endocrine dysfunction

  • Impaired glucose tolerance 
  • Type 2 Diabetes mellitus    
  • Hypothyroidism
  • Obesity
  • Dyslipidaemia

Ears

  • Otitis media
  • Hearing deficits
  • deformity of external ear

Eyes

  • Epicanthic fold
  • Acuity deficit/strabisimus

Gastrointestinal dysfunction

  • Elevated liver enzymes

Physical appearance

  • Micrognathia/ high arched palate
  • Low posterior hairline
  • Broad short neck/ webbed neck
  • Broad chest with widely spaced nipples
  • Cubitus valgus
  • Short fourth metacarpal
  • Genu valgum
  • Madelung deformity

Skeletal

  • Osteopaenia
  • Scoliosis

Skin

  • Lymphoedema
  • multiple pigmented naevi
  • viteligo

Psychosocial

  • Emotional immaturity
  • Unassertiveness/over compliance
  • Specific learning difficulties

Content created June 04, 2007  

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