Hormone replacement therapy may improve hepatic function in women with Turner's syndrome

OBJECTIVE Women with Turner's syndrome (TS) have recently been shown to be at an increased risk of developing chronic liver disease. There has been so me concern that oestrogen replacement therapy may exacerbate hepatic dysfun ction. The aim of this study was to assess hepatic function in women with T S and to determine the effect of oral oestradiol valerate on liver enzymes. DESIGN AND PATIENTS A retrospective review of liver enzymes of 80 women wit h TS, followed by a prospective study looking at serum liver enzyme concent rations in 20 women with TS following 3 months on and off hormone replaceme nt therapy (HRT) (oestradiol valerate, 2 mg/levonorgestril 75 mug). MEASUREMENTS Liver enzymes (gamma glutamyl transferase, aspartate transamin ase and alkaline phosphatase), albumin and bilirubin were measured on and o ff HRT. Viral hepatitis serology and liver autoantibodies were tested in pa tients with abnormal liver function. RESULTS Thirty-five out of 80 women (44%) had elevated serum liver enzyme c oncentrations. Two women (2.5%) had a mildly raised serum bilirubin, but pr otein synthesis was normal in all subjects. HRT resulted in a significant f all in all liver enzymes (P < 0.05) but did not affect serum protein concen trations CONCLUSIONS Women with Turner's syndrome often have elevated liver enzymes. Oestrogen/progestagen therapy using oestradiol valerate improves liver fun ction in this group of patients. The mechanisms behind this are unclear.