Gravholt C H, Naeraa R W, Nyholm B, Gerdes L U, Christiansen E, Schmitz O, Christiansen J S
Department of Endocrinology M, University Hospital of Aarhus, Denmark.
Diabetes Care. 1998 Jul;21(7):1062-70. doi: 10.2337/diacare.21.7.1062.
To examine glucose metabolism, blood pressure, physical fitness, and lipid metabolism in adult untreated women with Turner's syndrome compared with a group of normal women and to examine the effects of female sex hormone substitution on these factors.
A total of 26 patients with Turner's syndrome were examined before and during sex hormone replacement with 17 beta-estradiol and norethisterone, and an age-matched control group (n = 24) was examined once. A frequently sampled intravenous glucose tolerance test was applied with minimal model assessment. We also performed an oral glucose tolerance test, measurement of 24-h ambulatory blood pressure, and assessment of physical fitness and lipid metabolism.
Insulin sensitivity (SI) and glucose effectiveness (SG) were similar in Turner's syndrome patients and control subjects, whereas the acute insulin response (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 treatment 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 patients. Blood pressure was increased in Turner's syndrome, and a decrease was seen in diastolic blood pressure during treatment with sex hormones.
Turner's syndrome is associated with glucose intolerance, diminished first-phase insulin response, elevated blood pressure, reduced 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 known to have androgenic effects.
与一组正常女性相比，研究未经治疗的成年特纳综合征女性的葡萄糖代谢、血压、体能和脂质代谢，并研究女性性激素替代对这些因素的影响。
对26例特纳综合征患者在使用17β - 雌二醇和炔诺酮进行性激素替代治疗之前及治疗期间进行检查，对年龄匹配的对照组（n = 24）进行一次检查。采用频繁采样静脉葡萄糖耐量试验并进行最小模型评估。我们还进行了口服葡萄糖耐量试验、24小时动态血压测量以及体能和脂质代谢评估。
特纳综合征患者和对照组的胰岛素敏感性（SI）和葡萄糖效能（SG）相似，而特纳综合征患者的急性胰岛素反应较低（P = 0.03），且在性激素治疗期间未见变化。50%的特纳综合征患者在治疗前葡萄糖耐量异常，在性激素治疗期间这一比例为78%。与对照组相比，特纳综合征患者的去脂体重（FFM；P = 0.0005）和体能（P = 0.002）较低。在治疗期间，特纳综合征患者的FFM（P = 0.001）和体能（P = 0.02）有所增加。特纳综合征患者血压升高，在性激素治疗期间舒张压下降。
特纳综合征与葡萄糖不耐受、第一相胰岛素反应减弱、血压升高、FFM降低和体能下降有关。性激素给药会导致葡萄糖耐量恶化，增加FFM和体能，并对血压产生有益影响。对葡萄糖耐量的有害影响可能由炔诺酮介导，炔诺酮是一种已知具有雄激素作用的孕激素。
