GLUCOSE-METABOLISM, LIPID-METABOLISM, AND CARDIOVASCULAR RISK-FACTORSIN ADULT TURNERS-SYNDROME - THE IMPACT OF SEX-HORMONE REPLACEMENT

OBJECTIVE-To examine glucose metabolism, blood pressure, physical fitn ess, and lipid metabolism in adult untreated women with Turner's syndr ome compared with a group of normal women and to examine the effects o f female sex hormone substitution on these factors. RESEARCH DESIGN AN D METHODS-A total of 26 patients with Turner's syndrome were examined before and during sex hormone replacement with 17 beta-estradiol and n orethisterone, and an age-matched control group (n = 24) was examined once. A frequently sampled intravenous glucose tolerance test was appl ied with minimal model assessment. We also performed an oral glucose t olerance test, measurement of 24-h ambulatory blood pressure, and asse ssment of physical fitness and lipid metabolism. RESULTS-Insulin sensi tivity (S-I) and glucose effectiveness (S-G) were similar in Turner's syndrome patients and control subjects, whereas the acute insulin resp onse (P = 0.03) was lower in Turner's syndrome patients, and no change was seen during sex hormone treatment. Abnormal glucose tolerance was found in 50% of Turner's syndrome patients before and 78% during trea tment with sex hormones. Fat-free mass (FFM; P = 0.0005) and physical fitness (P = 0.002) were lower in Turner's syndrome subjects compared with control subjects. During treatment, an increase in FFM (P = 0.001 ) and physical fitness (P = 0.02) was seen in Turner's syndrome patien ts. Blood pressure was increased in Turner's syndrome, and a decrease was seen in diastolic blood pressure during treatment with sex hormone s. CONCLUSIONS-Turner's syndrome is associated with glucose intoleranc e, diminished first-phase insulin response, elevated blood pressure, r educed FFM, and physical fitness. Sex hormone administration causes a deterioration in glucose tolerance, increases FFM and physical fitness , and has beneficial effects on blood pressure. The deleterious effect on glucose tolerance may be mediated by norethisterone, a gestagen kn own to have androgenic effects.