Increased prevalence of autoimmunity in Turner syndrome--influence of age

Clin Exp Immunol. 2009 May;156(2):205-10. doi: 10.1111/j.1365-2249.2009.03895.x. Epub 2009 Feb 26.

Abstract

Individuals with Turner syndrome (TS) are prone to develop autoimmune conditions such as coeliac disease (CD), thyroiditis and type 1 diabetes (T1DM). The objective of the present study was to examine TS of various karyotypes for autoantibodies and corresponding diseases. This was investigated in a prospective cross-sectional study of Danish TS patients (n = 107, median age 36.7 years, range: 6-60 years). A medical history was recorded and a blood sample was analysed for autoantibodies against gliadin, transglutaminase, adrenal cortex, intrinsic factor, anti-thyroid peroxidase (anti-TPO) and glutamic-acid-decarboxylase 65 (GAD-65). Autoantibodies were present in 58% (n = 61) of all patients, whereof 18% (11) had autoantibodies targeting more than one organ. Patients with autoantibodies were significantly older than those without (P = 0.001). Anti-TPO was present in 45% (48) of patients, of whom 33% (16) were hypothyroid. Overall, 18% (19) presented with CD autoantibodies, of whom 26% (five) had CD. Anti-TPO and CD autoantibodies co-existed in 9% (10). Immunoglobulin A deficiency was found in 3% (three) of patients, who all had CD autoantibodies without disease. Among four patients with anti-GAD-65 none had T1DM, but two were classified as having T2DM. One patient had adrenocortical autoantibodies but not adrenal failure. Autoantibodies against intrinsic factor were absent. Anti-GAD-65 was increased in isochromosomal karyotypes (3/23 versus 1/84, P = 0.008) with no other association found between autoantibodies and karyotype. In conclusion, TS girls and women face a high prevalence of autoimmunity and associated disease with a preponderance towards hypothyroidism and CD. Thus, health care providers dealing with this patient group should be observant and test liberally for these conditions even before clinical symptoms emerge.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aging / immunology*
  • Autoantibodies / blood
  • Autoimmune Diseases / complications*
  • Autoimmune Diseases / immunology
  • Celiac Disease / complications
  • Celiac Disease / immunology
  • Chi-Square Distribution
  • Child
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / immunology
  • Female
  • Glutamate Decarboxylase / immunology
  • Humans
  • Hypothyroidism / complications
  • Hypothyroidism / immunology
  • IgA Deficiency / complications
  • IgA Deficiency / immunology
  • Iodide Peroxidase / immunology
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Risk
  • Turner Syndrome / complications
  • Turner Syndrome / immunology*
  • Young Adult

Substances

  • Autoantibodies
  • Iodide Peroxidase
  • Glutamate Decarboxylase
  • glutamate decarboxylase 2