The quality of life of Turner women in comparison with grown-up GH-deficient women

Social skills and relationships in Turner syndrome

PURPOSE OF REVIEW

Summarize the literature on the social skills and relationships of women with Turner syndrome and examine the biological and psychological factors that may contribute to social interaction difficulties.

RECENT FINDINGS

Turner syndrome is often associated with impaired social-cognitive processing and executive function deficits. These cognitive abnormalities, together with a range of physical differences, may adversely affect social communication skills, which typically begin to impair quality of life during early adolescence. Parental accounts of their daughter's social skills frequently highlight interaction problems, both in the home and beyond; in contrast, self-reports are usually far more positive. At present, we do not know the extent to which such self-reports reflect a lack of social awareness, or a lack of concern about social difficulties.

SUMMARY

Women with Turner syndrome are likely to experience social interaction challenges (especially in friendships and relationships) across the lifespan. Providing appropriate guidance and support to them demands a better understanding of their strengths and weaknesses.

The investigation of quality of life in 87 Chinese patients with disorders of sex development

Objective. In the process of care for disorders of sex development (DSD), clinical decisions should focus on the long-term quality of life (QOL). We sought to investigate the QOL of patients with DSD in China. Design. Case-control study was carried out. Patients. 90 patients of DSD participated in the study. Finally, 87 patients were analyzed including Turner's syndrome (23), Noonan syndrome (2), androgen insensitivity syndrome (22), testicular regression syndrome (2), congenital adrenal hyperplasia (16), and pure gonadal dysgenesis (22). Measurements. The WHOQOL-BREF questionnaire was chosen for the present investigation. Four domain scores were analyzed independently including physical, psychological, and social relationship and environmental domains. Results. The average age of the DSD group is 22.34 ± 4.97 years, and only 13.79% patients ever had sexual life. The scores of psychological and environmental domains were lower than that of the physical and social relationship domains, but the difference was not significant (P > 0.05). Compared with the Chinese urban population, the QOL scores of DSD patients in China were not significantly lower. Conclusions. With proper treatment, including the follow-up and psychological support, the QOL of DSD patients cannot be significantly reduced. For DSD patients, more attention should be paid to the potential psychological and sexual problems.

Socioeconomic parameters and mortality in Turner syndrome

BACKGROUND

Turner syndrome (TS) is characterized by hypogonadism, short adult height, increased morbidity and mortality, contrasted by self-reported normal quality of life and perception of health. Small studies have indicated a similar level of education compared with the background population.

AIM

To study the socioeconomic profile in TS and the impact of these factors on mortality.

MATERIALS AND METHODS

Register study using Danish nationwide registries. Nine hundred and seventy-nine TS females and 94,850 controls were included. Information concerning cohabitation, motherhoods, level of education (bachelor degree), income, retirement, and death were obtained. One hundred and three TS and 5989 controls died during the study period. For the socioeconomic parameters, median age at first relevant episode was calculated. Income was analyzed using conditional logistic regression and the other parameters using Cox regression.

RESULTS

In comparison with controls, TS had significantly fewer partnerships (hazard ratio (HR): 0.45), fewer motherhoods (HR: 0.18), and retired earlier (HR: 1.8). After the diagnosis of TS, the risk of retiring was increased. Educational attainment (HR: 1.0) as well as risk of unemployment was similar. Before the age of 30, low income was significantly more frequent; hereafter, it was similar to controls. Mortality was significantly increased (HR: 2.9) and slightly lower after adjustment for cohabitation and education (HR: 2.7).

CONCLUSIONS

A divergent socioeconomic profile is apparent, with a reduced proportion of TS persons finding a partner and becoming mothers. The educational level was similar to controls. The increased mortality in TS was not materially affected after adjustment for cohabitation and education.

Quality of life after growth hormone therapy and induced puberty in women with Turner syndrome

OBJECTIVE

To evaluate health-related quality of life (HRQoL) in young women with Turner syndrome (TS) after long-term growth hormone (GH) therapy and induced puberty and to analyze whether HRQoL was influenced by auxologic parameters, pubertal development, or subjective parameters.

STUDY DESIGN

The study group comprised 49 women with TS, mean (standard deviation) age 19.6 (+/-3.0) years, all former participants of 2 GH studies, > or =6 months after GH discontinuation. Puberty was induced by estrogen treatment, at mean age 12.9 (+/-1.1) years. HRQoL was measured by self-reports of the 2 generic questionnaires, SF36 and TAAQOL. As an additional source of information on HRQoL, we applied parental proxy reports.

RESULTS

HRQoL of the women with TS was normal. Remarkably, the women with TS had higher HRQoL scores on some of the scales, including "social functioning" and "role-emotional." Satisfaction with height and breast development had a positive influence on several HRQoL scales.

CONCLUSIONS

The young women with TS who reached normal height and had age-appropriate pubertal development reported normal HRQoL. The relatively high scores on some of the HRQoL scales can be explained by an estrogen effect or by a possible response shift, indicating a different internal reference in women with TS. We hypothesize that GH and estrogen treatment positively influenced HRQoL in young women with TS.

Aspectos psicossociais da síndrome de Turner

A síndrome de Turner (ST) ocorre em aproximadamente 1:2.130 nativivos do sexo feminino e os sinais clínicos mais importantes são a baixa estatura e a disgenesia gonadal, levando a amenorréia primária, atraso no desenvolvimento puberal e esterilidade. Podem ser observadas, também, anomalias congênitas e adquiridas e uma grande variabilidade de sinais dismórficos. Assim, a presença de tantos sinais e sintomas, bem como a magnitude dos mesmos pode causar graves conseqüências no funcionamento psicológico e social das pacientes com ST. O objetivo deste artigo consiste numa revisão de literatura a respeito dos aspectos psicológicos da ST. As principais áreas abordadas são: impacto psicossocial da baixa estatura, do atraso no desenvolvimento puberal e da infertilidade, auto-estima, aspectos sociais, identidade de gênero, relacionamentos amorosos e funcionamento sexual, relações familiares, funcionamento cognitivo, doenças psiquiátricas e a presença de uma "doença crônica". Considerações gerais para o acompanhamento psicológico dessas pacientes também são discutidas.

Turner's syndrome in adulthood

Turner's syndrome is the most common chromosomal abnormality in females, affecting 1:2,500 live female births. It is a result of absence of an X chromosome or the presence of a structurally abnormal X chromosome. Its most consistent clinical features are short stature and ovarian failure. However, it is becoming increasingly evident that adults with Turner's syndrome are also susceptible to a range of disorders, including osteoporosis, hypothyroidism, and renal and gastrointestinal disease. Women with Turner's syndrome have a reduced life expectancy, and recent evidence suggests that this is due to an increased risk of aortic dissection and ischemic heart disease. Up until recently, women with Turner's syndrome did not have access to focused health care, and thus quality of life was reduced in a significant number of women. All adults with Turner's syndrome should therefore be followed up by a multidisciplinary team to improve life expectancy and reduce morbidity.

Women with Turner syndrome: psychological well-being, self-rated health and social life

Psychological well-being, self-rated health and social situation were investigated in a cross-sectional multidisciplinary study of 63 women with Turner syndrome (TS; mean age 31.5 years, range 18-59 years). The psychological examination included a semi-structured interview, and use of two standardized self-rating scales, the Psychological General Well-being Index (PGWB) and the Nottingham Health Profile (NHP). Psychological well-being and self-rated health were similar in the women with TS and Swedish female normative data, matched for age. However, the women with TS reported more social isolation than the normative group. Within the TS group, the oldest women reported more psychological distress and poorer health than the youngest. Those with impaired self-rated health reported more emotional distress. The women with TS were studying or in employment to the same degree as the general population, although fewer were cohabiting. In the interview, both negative and positive consequences of TS were reported. This study did not find any evidence for impaired psychological well-being, although it did indicate that women with TS experience more difficulties in the area of social and partner relationships.

Psychological aspects of Turner syndrome

Turner syndrome (TS) is a sex-chromosome disorder, occurring in 1 in 2500 female births. The principal features of TS are short stature and dysfunctional gonads, resulting in a lack of sex hormones, incomplete pubertal development and impaired fertility. The aim of this paper is to review the literature on the psychological effects of TS. The main areas covered relate to well-being and psychopathology, self-esteem, social functioning, gender identity, partner relations and sexual functioning, coping, family aspects and clinical aspects of cognitive impairment. Research on the psychological effects of medical intervention is described, and the methods used for psychological and educational support are presented. Finally, methodological issues are discussed and areas for future research are proposed.