Skip to main content
Log in

Ambulatory Blood Pressure and Subclinical Cardiovascular Disease in Children With Turner Syndrome

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Patients with Turner syndrome (TS) have an increased risk of cardiovascular morbidity. 29 TS and 25 healthy control subjects (CS) were included in the study. We investigated body mass index, waist circumference, fasting glucose and insulin, homeostatic model assessment (HOMA) index, serum lipids, oral glucose tolerance test, 24-h ambulatory blood pressure (BP) monitoring, and carotid intima-media thickness (CIMT) and compared them with CS. 28 % (N = 7) of TS had insulin resistance (IR), and 36 % (N = 9) had IGT. Mean systolic BP and diastolic BP (DBP) dip were 7.24 ± 3.97 % and 11.84 ± 6.2 %, respectively. CIMT was greater in TS than in CS (p = 0.00). CIMT was correlated positively with fasting insulin, HOMA index, and insulin-sensitivity check index (r = 0.563, p = 0.015; r = 0.603, p = 0.008; and r = 0.623, p = 0.006, respectively) and negatively with fasting glucose-to-insulin ratio and DBP dipping (r = −0.534, p = 0.022; r = −0.534, p = 0.00, respectively) in the two groups combined. These results provide additional evidence for the presence of subclinical cardiovascular disease and its relation to hypertension in TS. They also indicate a significant relation between DBP dipping and increased arterial stiffness. It is also important to note that our findings show significant relationships between insulin sensitivity and cardiovascular changes and underline the importance of insulin resistance for predicting cardiovascular disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bonithon-Kopp C, Touboul PJ, Berr C, Leroux C, Mainard F, Courbon D et al (1996) Relation of intima-media thickness to atherosclerotic plaques in the carotid arteries: the vascular aging (EVA) study. Arterioscler Thromb Vasc Biol 16(2):310–331

    Article  CAS  PubMed  Google Scholar 

  2. Caprio S, Boulware S, Diamond M, Sherwin RS, Carpenter TO, Rubin K et al (1991) Insulin resistance: an early metabolic defect of Turner’s syndrome. J Clin Endocrinol Metab 72(4):832–836

    Article  CAS  PubMed  Google Scholar 

  3. Cicognani A, Mazzanti L, Tassinari D, Pellacani A, Forabosco A, Landi L et al (1998) Differences in carbohydrate tolerance in Turner syndrome depending on age and karyotype. Eur J Pediatr 148(1):64–68

    Article  Google Scholar 

  4. Goran MI, Gower BA (2001) Longitudinal study on pubertal insulin resistance. Diabetes 50(11):2444–2450

    Article  CAS  PubMed  Google Scholar 

  5. Gravholt CH, Naeraa RW, Nyholm B (1988) Glucose metabolism, lipid metabolism, and cardiovascular risk factors in adult Turner syndrome: the impact of sex hormone replacement. Diabetes Care 21(7):1062–1070

    Article  Google Scholar 

  6. Gravholt CH, Juul S, Naeraa RW (1998) Morbidity in Turner syndrome. J Clin Epidemiol 51(2):147–158

    Article  CAS  PubMed  Google Scholar 

  7. Haeusler G, Frisch H (1992) Growth hormone treatment in Turner’s syndrome: short- and long-term effects on metabolic parameters. Clin Endocrinol 36(3):247–253

    Article  CAS  Google Scholar 

  8. Holl RW, Kunze D, Etzrodt H, Teller W, Heinze E (1994) Turner syndrome: final height, glucose tolerance, bone density and psychosocial status in 25 adult patients. Eur J Pediatr 153(1):11–16

    Article  CAS  PubMed  Google Scholar 

  9. Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G et al (2000) Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab 85(7):2402–2410

    Article  CAS  PubMed  Google Scholar 

  10. Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C (2005) Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics 115(4):500–503

    Article  Google Scholar 

  11. Mahabala C, Kamath P, Bhaskaran U, Pai ND, Pai AU (2013) Antihypertensive therapy: nocturnal dippers and nondippers. Do we treat them differently? Vasc Health Risk Manag 9:125–133

    Article  PubMed Central  PubMed  Google Scholar 

  12. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28(7):412–419

    Article  CAS  PubMed  Google Scholar 

  13. Nathwani NC, Unwin R, Brook CG (2000) Blood pressure and Turner syndrome. Clin Endocrinol 52(3):363–370

    Article  CAS  Google Scholar 

  14. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114(2 Suppl 4th Report):555–576

    Article  Google Scholar 

  15. Newman WP, Freedman DS, Voors DW, Gard PD, Srinivasan SR, Cresanta JL et al (1986) Relation of serum lipoprotein levels and systolic blood pressure to early atherosclerosis. The Bogalusa Heart Study. New Engl J Med 14(3):138–144

    Article  Google Scholar 

  16. Nielsen J, Johansen K, Yde H (1969) The frequency of diabetes mellitus in patients with Turner’s syndrome and pure gonadal dysgenesis: blood glucose, plasma insulin and growth hormone level during an oral glucose tolerance test. Acta Endocrinol 62(2):251–269

    CAS  PubMed  Google Scholar 

  17. Pirgon Ö, Atabek ME, Oran B, Güçlü R (2008) Atherogenic lipid profile and systolic blood pressure are associated with carotid artery intima-media thickness in children with Turner syndrome. J Clin Res Pediatr Endocrinol 1(2):62–71

    Article  PubMed Central  PubMed  Google Scholar 

  18. Price WH, Clayton JF, Collyer S (1986) Mortality ratios, life expectancy, and causes of death in patients with Turner’s syndrome. J Epidemiol Commun Health 40(2):97–102

    Article  CAS  Google Scholar 

  19. Riley WA, Barnes RW, Applegate WB, Dempsey R, Hartwell T, Davis VG et al (1992) Reproducibility of noninvasive ultrasonic measurement of carotid atherosclerosis: the asymptomatic carotid artery plaque study. Stroke 23(8):1062–1068

    Article  CAS  PubMed  Google Scholar 

  20. Salonen JT, Salonen R (1993) Ultrasound B-mode imaging in observational studies of atherosclerotic progression. Circulation 87(3 Suppl):II56–II65

    CAS  PubMed  Google Scholar 

  21. Schoemaker MJ, Swerdlow AJ, Higgins CD (2008) Mortality in women with Turner syndrome in Great Britain: a national cohort study. J Clin Endocrinol Metab 93(12):4735–4742

    Article  CAS  PubMed  Google Scholar 

  22. Stochholm K, Juul S, Juel K, Naeraa RW, Gravholt CH (2006) Prevalence, incidence, diagnostic delay, and mortality in Turner syndrome. J Clin Endocrinol Metab 91(10):3897–3902

    Article  CAS  PubMed  Google Scholar 

  23. Stoppoloni G, Prisco F, Alfano C (1990) Characteristics of insulin resistance in Turner syndrome. Diabetes Metab 16(4):267–271

    CAS  Google Scholar 

  24. Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein N et al (2007) Mannheim carotid intima-media thickness consensus (2004–2006). An update on behalf of the Advisory Board of the 3rd and 4th Watching the Risk Symposium, 13th and 15th European Stroke Conferences, Mannheim, Germany, 2004, and Brussels, Belgium, 2006. Cerebrovasc Dis 23(1):75–80

    Article  PubMed  Google Scholar 

  25. Turner HH (1938) A syndrome of infantilism, congenital webbed neck, and cubitus valgus. Endocrinology 28:566

    Article  Google Scholar 

  26. Urbina E, Alpert B, Flynn J, Hayman L, Harshfield GA, Jacobson M et al (2008) Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young and the Council for High Blood Pressure Research. Hypertension 52(3):433–451

    Article  CAS  PubMed  Google Scholar 

  27. Van PL, Bakalov VK, Bondy CA (2006) Monosomy for the X-chromosome is associated with an atherogenic lipid profile. J Clin Endocrinol Metab 91(8):2867–2870

    Article  CAS  PubMed  Google Scholar 

  28. Verdecchia P, Schillaci G, Guerrieri M, Gatteschi C, Benemio G, Boldrini F et al (1990) Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation 81(2):528–536

    Article  CAS  PubMed  Google Scholar 

  29. Wilson DM, Frane JW, Sherman B, Johanson AJ, Hintz RL, Rosenfeld RG (1988) Carbohydrate and lipid metabolism in Turner syndrome: effect of therapy with growth hormone, oxandrolone, and a combination of both. J Pediatr 112(2):210–217

    Article  CAS  PubMed  Google Scholar 

  30. World Health Organization (1999) WHO consultation: Definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO consultation. Part 1: Diagnosis and classification of diabetes mellitus. WHO/NCD/NCS/99.2. WHO, Geneva, Switzerland

  31. Zimmet P, Alberti G, Kaufman F, Tajima N, Silink M, Arslanian S et al (2007) International diabetes federation task force on epidemiology and prevention of diabetes. The metabolic syndrome in children and adolescents. Lancet 369(9579):2059–2061

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank all of the patients who participated in this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nesibe Akyürek.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Akyürek, N., Atabek, M.E., Eklioglu, B.S. et al. Ambulatory Blood Pressure and Subclinical Cardiovascular Disease in Children With Turner Syndrome . Pediatr Cardiol 35, 57–62 (2014). https://doi.org/10.1007/s00246-013-0740-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-013-0740-2

Keywords

Navigation