A beneficial effect of estradiol on blood pressure, not on glucose and lipids levels in women with Turner syndrome
Abstract
Introduction. Turner syndrome (TS) is the form of gonadal malfunction. Arterial hypertension, elevated LDL and glucose and decreased HDL levels are characteristic of TS-women. Hormone therapy is a treatment for short stature and sex hormone deficits. Hormonal replacement therapy (HRT) reduces the risk of cardiovascular diseases. A large percentage of TS-women do not comply with doctors’ orders regarding HRT.
The analysis of 17β estradiol (E2) levels and the assessment of blood pressure, lipid and carbohydrate metabolisms in TS-women it is possible to state whether HRT decreases the risk of cardiovascular diseases?
Material and methods. The group of 95 TS-women, who declared HRT, were investigated. The information about HRT was collected during the anamnesis. E2, total cholesterol (TC), high (HDL) and low (LDL) density lipoproteins, triglycerides (TG) and glucose were assessed. Patients were divided into subgroups with E2 ≥ 110 pmol/L (n = 34) (HE) and < 110 pmol/L (n = 61) (LE) respectively.
Results. Arterial hypertension was diagnosed in 26.3%. The groups did not differ in systolic 119 ± 20 versus 118 ± 14 and diastolic 82 ± 13 versus 80 ± 10 mm Hg blood pressure. Despite the higher concentrations of E2 in HE, no differences were found in weights, lipids and glucose concentrations. Negative correlations between E2 and body mass (r = –0.25, p = 0.04) and diastolic blood pressure (r = –0.28, p = 0.02) as well as positive between E2 and glucose (r = 0.24, p < 0.05) were observed only in HE. No correlations between E2 and lipids were found.
Conclusions. 1. Only 1/3 TS-women, who declare HRT, have a satisfactory level of E2.
- In TS-women HRT does not affect glucose and lipid metabolisms.
3. Negative correlation between E2 and diastolic blood pressure in TS-women suggest beneficial effect of estrogens in hypertension.
Keywords: Turner syndromearterial hypertensionestradiolcarbohydrateslipids
References
- TURNER H. A SYNDROME OF INFANTILISM, CONGENITAL WEBBED NECK, AND CUBITUS VALGUS1. Endocrinology. 1938; 23(5): 566–574.
- Davenport ML. Approach to the patient with Turner syndrome. J Clin Endocrinol Metab. 2010; 95(4): 1487–1495.
- Jez W, Makieła E, Lewandowski P. [Pregnancy in a woman with Turner syndrome--two new cases]. Ginekol Pol. 2006; 77(4): 307–309.
- Lippe B. Turner syndrome. Endocrinol Metab Clin North Am. 1991; 20(1): 121–152.
- Omoe K, Endo A. Relationship between the monosomy X phenotype and Y-linked ribosomal protein S4 (Rps4) in several species of mammals: a molecular evolutionary analysis of Rps4 homologs. Genomics. 1996; 31(1): 44–50.
- Jeż W, Irzyniec T, Pyrkosz A. Selected problems of the diagnosis of Turner’s syndrome. Przeg Lek. 2007; 64: 130–133.
- Gravholt CH, Landin-Wilhelmsen K, Stochholm K, et al. Clinical and epidemiological description of aortic dissection in Turner's syndrome. Cardiol Young. 2006; 16(5): 430–436.
- Schoemaker MJ, Swerdlow AJ, Higgins CD, et al. United Kingdom Clinical Cytogenetics Group. Mortality in women with turner syndrome in Great Britain: a national cohort study. J Clin Endocrinol Metab. 2008; 93(12): 4735–4742.
- Gravholt CH. Clinical practice in Turner syndrome. Nat Clin Pract Endocrinol Metab. 2005; 1(1): 41–52.
- Ho VB, Bakalov VK, Cooley M, et al. Major vascular anomalies in Turner syndrome: prevalence and magnetic resonance angiographic features. Circulation. 2004; 110(12): 1694–1700.
- Irzyniec TJ, Jeż W. The influence of hormonal replacement and growth hormone treatment on the lipids in Turner syndrome. Gynecol Endocrinol. 2014; 30(3): 250–253.
- Freriks K, Timmermans J, Beerendonk CCM, et al. Standardized multidisciplinary evaluation yields significant previously undiagnosed morbidity in adult women with Turner syndrome. J Clin Endocrinol Metab. 2011; 96(9): E1517–E1526.
- De Groote K, Demulier L, De Backer J, et al. Arterial hypertension in Turner syndrome: a review of the literature and a practical approach for diagnosis and treatment. J Hypertens. 2015; 33(7): 1342–1351.
- Mortensen KH, Andersen NH, Gravholt CH. Cardiovascular phenotype in Turner syndrome--integrating cardiology, genetics, and endocrinology. Endocr Rev. 2012; 33(5): 677–714.
- Lastra G, Syed S, Kurukulasuriya LR, et al. Type 2 diabetes mellitus and hypertension: an update. Endocrinol Metab Clin North Am. 2014; 43(1): 103–122.
- Zuckerman-Levin N, Zinder O, Greenberg A, et al. Physiological and catecholamine response to sympathetic stimulation in turner syndrome. Clin Endocrinol (Oxf). 2006; 64(4): 410–415.
- Maric-Bilkan C, Gilbert EL, Ryan MJ. Impact of ovarian function on cardiovascular health in women: focus on hypertension. Int J Womens Health. 2014; 6: 131–139.
- Wacław J, Irzyniec TJ. Hormonal replacement therapy in women with Turner's syndrome in Poland: Analysis of 176 cases. Gynecol Endocrinol. 2009; 25(8): 546–550.
- Bulun S. Physiology and Pathology of the Female Reproductive Axis. Williams Textbook of Endocrinology. 2011: 581–660.
- Melmed S, Kleinberg D, Ho K. Pituitary Physiology and Diagnostic Evaluation. Williams Textbook of Endocrinology. 2011: 175–228.