medwireNews: Vasculopathy is already present in girls with Turner syndrome (TS) as young as 9 years old, researchers report.

The team detected functional changes, but not the structural changes observed in older patients, suggesting that structural damage may follow as patients get older.

Speaking to medwireNews, Martin Savage (Barts and the London School of Medicine & Dentistry, UK), who was not involved in the study, explained that “the nature of arterial vasculopathy in children with TS is complex, but appears to predict more serious and established changes in adult life.”

The researchers, led by Sarah Lawson (Cincinnati Children’s Hospital Medical Center, Ohio, USA), identified distinct functional vascular changes in 49 TS patients aged between 9 and 20 years (average 12 years). Three measures of arterial stiffness were significantly increased in these girls compared with 76 lean and 52 obese control girls, who were around 18 years of age.

Although the methods used were noninvasive, Savage said that they are “generally beyond the scope of paediatric endocrinologists caring routinely for these patients.”

He added: “A formal cardiological assessment before or at the time of puberty would seem to be indicated and may give useful predictors for future cardiovascular morbidity.”

The average Augmentation Index after adjusting for age and body mass index (BMI) standard deviation (SD) score was 0.33% in the TS patients, significantly higher than the 0.15% and 0.18% recorded in the lean and obese controls groups, respectively. Similarly, Young’s Elastic Modulus was 0.6 mmHg/mm versus –0.03 mmHg/mm in the lean controls and 0.26 mmHg/mm in the obese controls.

Femoral pulse wave velocity was initially lower in the TS patients than the control groups, but after adjusting for age and BMI SD score it was significantly higher in the TS patients relative to the lean controls.

Lawson et al found no evidence of structural vascular changes, however. Indeed, after adjusting for age and BMI SD, carotid intima-media thickness was lower in the TS patients than in the lean and obese controls, at 0.39 mm versus 0.45 and 0.47 mm, respectively.

The researchers note that the functional differences observed persisted after accounting for BMI, despite the TS patients having a higher BMI, on average, than the lean controls, suggesting that a tendency to obesity does not account for the vascular changes seen.

Thus the “inherent early vessel disease likely places the TS population at an additional disadvantage before environmental factors play their part”, they write in the Journal of Clinical Endocrinology & Metabolism.

By Eleanor McDermid, Senior medwireNews Reporter

J Clin Endocrinol Metab 2014; Advance online publication

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