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Turner Syndrome with Y Chromosome: Spontaneous Thelarche, Menarche, and Risk of Malignancy

Authors :
Vrunda Patel
YeoChing Hsu
Shanlee M Davis
Elizabeth Dabrowski
Reema L. Habiby
Courtney Finlayson
Emilie K. Johnson
Allison L. Goetsch
Wendy J. Brickman
Source :
J Pediatr Adolesc Gynecol
Publication Year :
2019

Abstract

Study Objective Girls with Turner syndrome with Y-chromosome material (TS + Y) are assumed to have nonfunctional gonads with increased tumor risk, therefore prophylactic gonadectomy is recommended at diagnosis. In this study we aimed to determine rates of spontaneous thelarche (ST) and spontaneous menarche (SM), and prevalence of gonadal tumor and malignancy in girls with TS + Y, to further inform discussions about gonadectomy. Design Retrospective review of clinical and pathology data. Setting Multicenter study involving 4 United States children's hospitals. Participants Patients included those with a genetically proven diagnosis of TS + Y and phenotypically female genitourinary exam. Interventions Demographic characteristics, pubertal development, and gonadal pathology data were abstracted from clinical records. Data for ST were analyzed for patients aged 13 years and older and SM for patients older than 15 years. Main Outcome Measures ST, SM, prevalence of gonadal tumor, and malignancy. Results Forty-four patients met inclusion criteria. Nineteen patients were 13 years or older; 8/19 (42%) had ST and reached Tanner stages 2-4 and 2 (11%) had normal ovarian pathology. Nineteen patients were 15 years or older; 2/19 (11%) had SM. Thirty-seven patients underwent gonadectomy; 35 had available pathology results. Gonadoblastoma was identified in 35/7 patients (19%), 1 in situ germ cell neoplasia, and 1 dysgerminoma (3%). One patient with bilateral gonadoblastoma had ST and SM. Conclusion In this multicenter cohort, 42% of girls with TS + Y entered puberty spontaneously and 11% had SM, supportive of gonadal function. Risk of tumor was similar to previous reports. To achieve informed decision-making, discussions about gonadectomy should incorporate potential for gonadal function and tumor risk.

Details

ISSN :
18734332
Volume :
33
Issue :
1
Database :
OpenAIRE
Journal :
Journal of pediatric and adolescent gynecology
Accession number :
edsair.doi.dedup.....2d8abd4444a2e8f2aacf87769695cc19