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Turner Syndrome

(Turner's Syndrome; Monosomy X; XO Syndrome)

By

Nina N. Powell-Hamilton

, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Last full review/revision Jul 2020| Content last modified Jul 2020
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Topic Resources
  • Turner syndrome is caused by the deletion of part or all of one of the two X chromosomes.

  • Girls with the syndrome are typically short and with loose skin on the back of the neck, learning disabilities, and an inability to undergo puberty.

  • The diagnosis is confirmed by analyzing the chromosomes.

  • Treatment with hormones can stimulate growth and initiate puberty.

The sex chromosomes Sex chromosomes Genes are segments of deoxyribonucleic acid (DNA) that contain the code for a specific protein that functions in one or more types of cells in the body. Chromosomes are structures within cells... read more Sex chromosomes determine whether a fetus becomes male or female. A pair of X and Y chromosomes (XY) results in a male, and a pair of X and X chromosomes (XX) results in a female.

Turner syndrome occurs in about 1 out of 2,500 live female births. However, this chromosome abnormality is much more common at conception, but 99% of affected fetuses abort spontaneously.

Symptoms of Turner Syndrome

Some symptoms of Turner syndrome are noticeable at birth. Other symptoms are not noticed until the children are school-age or older.

Infants

Many newborns with Turner syndrome are mildly affected, but some have swelling (lymphedema Lymphedema Lymphedema is the accumulation of lymph in tissues, resulting in swelling. When lymphatic vessels are injured or obstructed, lymph fluid cannot drain and accumulates in tissues, causing swelling... read more Lymphedema ) on the backs of their hands and tops of their feet. Swelling or loose folds of skin are often evident over the back of the neck. Heart defects include narrowing of part of the aorta (coarctation of the aorta Coarctation of the Aorta Coarctation of the aorta is a narrowing of part of the aorta, the main blood vessel bringing red oxygenated blood from the heart to the body. The aorta narrows, causing the heart to pump harder... read more Coarctation of the Aorta ). Other abnormalities seen later include a webbed neck (wide skin attachment between the neck and shoulders) and a broad chest with widely spaced and inwardly turned nipples. Infants are at a higher risk of a problem with the hip joint called developmental dysplasia of the hip Developmental Dysplasia of the Hip Developmental dysplasia of the hip is a birth defect in which the bones in the hip may be incorrectly developed. In developmental dysplasia of the hip, formerly called congenital dislocation... read more . Less common symptoms include drooping upper eyelids (ptosis), a low hairline at the back of the neck, moles Moles Moles are small, usually dark, skin growths that develop from pigment-producing cells in the skin (melanocytes). Most people have some moles, but the tendency to develop atypical moles is sometimes... read more Moles (nevi), and poorly developed nails.

Older children and adolescents

Girls with Turner syndrome generally do not have menstrual periods (amenorrhea Absence of Menstrual Periods Having no menstrual periods is called amenorrhea. Amenorrhea is normal in the following circumstances: Before puberty During pregnancy While breastfeeding read more ), and the breasts, vagina, uterus, and labia remain childlike rather than undergoing the changes of puberty (delayed puberty Delayed Puberty Delayed puberty is defined as absence of the start of sexual maturation at the expected time. Most often, children simply develop later than their peers but ultimately develop normally. Sometimes... read more ). About 10% of adolescents have scoliosis Scoliosis Scoliosis is abnormal curvature of the spine. Scoliosis can be present at birth or can develop during adolescence. Mild forms may cause only mild discomfort, but more severe forms can cause... read more Scoliosis . In 90% of girls, the ovaries are replaced by connective tissue and do not contain developing eggs (gonadal dysgenesis), so these girls are infertile. A girl or woman with Turner syndrome is often short compared with family members, and obesity is common.

Other disorders may develop. High blood pressure High Blood Pressure High blood pressure (hypertension) is persistently high pressure in the arteries. Often no cause for high blood pressure can be identified, but sometimes it occurs as a result of an underlying... read more High Blood Pressure frequently occurs with aging even if the girl does not have coarctation. Kidney defects, diabetes mellitus Diabetes Mellitus (DM) in Children and Adolescents Diabetes mellitus is a disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin or fails to respond normally to the insulin produced... read more Diabetes Mellitus (DM) in Children and Adolescents , and thyroid diseases are common. Occasionally, abnormal blood vessels in the intestine cause bleeding. Hearing loss Hearing Impairment in Children Hearing loss in newborns most commonly results from cytomegalovirus infection or genetic defects and in older children results from ear infections or earwax. If children do not respond to sounds... read more Hearing Impairment in Children occurs, and crossed eyes (strabismus Strabismus Strabismus is an intermittent or constant misalignment of an eye so that its line of vision is not pointed at the same object as the other eye. If untreated, strabismus can cause amblyopia ... read more Strabismus ) and farsightedness (hyperopia) are common. Celiac disease Celiac Disease Celiac disease is a hereditary intolerance to gluten (a protein found in wheat, barley, and rye) that causes characteristic changes in the lining of the small intestine, resulting in malabsorption... read more Celiac Disease , inflammation of the thyroid gland, and diabetes mellitus occur more frequently among girls with Turner syndrome than among the general population. There is an increased risk of an enlarged aorta so girls need to be screened regularly with echocardiography.

Diagnosis of Turner Syndrome

Treatment of Turner Syndrome

  • Surgical repair of heart defects

  • Growth hormone therapy

  • Estrogen replacement therapy

  • Regular evaluations for other problems

There is no cure for Turner syndrome. However, some specific symptoms and problems caused by the syndrome can be treated. Coarctation of the aorta is usually repaired surgically. Doctors monitor and repair other heart defects as needed. Lymphedema can usually be controlled with support hosiery and other techniques such as massage.

Treatment with growth hormone can stimulate growth. Once satisfactory growth has been achieved, treatment with growth hormone is stopped.

Treatment with the female hormone estrogen is usually needed to initiate puberty Puberty in Girls Puberty is a sequence of events in which physical changes occur, resulting in adult physical characteristics and capacity to reproduce. These physical changes are regulated by changes in the... read more and is typically given at age 12 to 13 but is usually not started until after satisfactory growth has been achieved. After girls have undergone puberty, they are given birth control pills that contain estrogen plus another female hormone, progestin. This hormone treatment helps girls maintain their female sexual characteristics. Estrogen treatment may also improve the girl’s ability to plan tasks, pay attention, and assess visual and spatial relationships and also helps the bones become dense and helps the skeleton develop properly.

Some girls who have Turner syndrome begin puberty normally without estrogen replacement therapy, but this is more common among girls who are mosaic. Girls who have mosaic Turner syndrome have a mixture of two or more types of cells. Some of their cells contain two X chromosomes and some cells contain just one X chromosome. Such girls may become pregnant but they usually require fertility treatments Assisted Reproductive Techniques Assisted reproductive techniques involve manipulating sperm and eggs or embryos in a laboratory (in vitro) with the goal of producing a pregnancy. (See also Overview of Infertility.) If treatment... read more Assisted Reproductive Techniques .

Girls with Turner syndrome should have regular evaluations to detect problems that may result from this disorder. Evaluations include the following:

  • Heart examinations

  • Kidney function tests

  • Hearing examinations

  • Bone evaluations (for disorders of the hips and spine)

  • Eye examinations by a pediatric ophthalmologist

  • Thyroid function tests

  • Screening tests for celiac disease

  • Blood tests for glucose (sugar) intolerance (starting at 10 years of age)

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