title: Medical care of girls with Turner Syndrome: where are we lacking?
abstract: OBJECTIVE
  To characterize the medical care of a large cohort of girls with Turner syndrome with a focus on changes in management since establishment of international consensus guidelines in 2007.
  
  
  METHODS
  We reviewed medical records of patients followed up for Turner syndrome between 2000 and 2010.
  
  
  RESULTS
  A total of 128 girls aged 13.2 ± 0.5 years were identified. Average age at diagnosis was 4.1 ± 5.1 years. Overall, medical assessments performed included a hearing test in 56%, thyroid screening in 95%, renal ultrasonography in 100%, and echocardiography in 100%. Before 2007, none of the patients had screening performed for celiac disease, dyslipidemia, or liver dysfunction, and none had routine electrocardiography or cardiac magnetic resonance imaging. Since 2007, 63% were screened for celiac disease, 54% for liver abnormalities, and 38% for dyslipidemia. Electrocardiography was performed in 23%, while cardiac magnetic resonance imaging was performed in 39%. Although conjugated equine oral estrogen was the main mode of estrogen replacement, a significant increase was noted in the use of transdermal estrogen during the past 2 years compared with that observed in the earlier interval (78% vs 10%, respectively).
  
  
  CONCLUSIONS
  Although changes in medical practice have occurred since establishment of the international Turner syndrome guidelines, screening for associated comorbidities was deficient in greater than 50% of the patients in our study. This is the first study evaluating medical care in a large cohort of pediatric patients with Turner syndrome, and our findings emphasize the need for continual education of all physicians involved in the care of this population.
authors: Department of Pediatric Endocrinology and Diabetology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA. znabhan@iupui.edu
authors: Zeina M
authors: ZM
authors: Nabhan
authors: Erica A
authors: EA
authors: Eugster
mesh_terms: D000293:Adolescent; D002648:Child; D004452:Echocardiography; D015914:Estrogen Replacement Therapy; D004966:Estrogens, Conjugated (USP) / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D014424:Turner Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology
chemical_list: D004966:Estrogens, Conjugated (USP)