ESPE Abstracts (2018) 89 P-P3-243

Increased Serum Activity of Liver Aminotransferases in Young Patients with Turner Syndrome

Malgorzata Wojcika, Anna Ruszalaa, Dominika Janusa, Krystyna Sztefkob & Jerzy B. Starzyka


aDepartment of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, Krakow, Poland; bDepartment of Clinical Biochemistry, Pediatric Institute, Jagiellonian University Medical College, Krakow, Poland


Background: Liver tests abnormalities are common in adult patients with Turner Syndrome (TS). The data regarding liver tests in children and adolescents with TS remain lacking.

Design and patients: A cross-sectional review of liver function of 100 girls with TS (age range 4–16, the mean BMI SDS 0.63 [−1,86 −6,78]); 56 receiving rhGH therapy (9 obese, 47 normal weight), and 44 receiving rhGH therapy and estrogen or estrogen/progesterone hormone replacement therapy (HRT)(8 obese and 36 normal weight). A longitudinal study included 81 patients (mean follow-up period: 3–5 years).

Measurements: Activity of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were measured in fresh serum samples using dry chemistry (Vitros).

Results: When compared to reference ranges, 34% of girls with TS demonstrated increased AST and ALT activity (32% without HRT, 36% on HRT), with not significant yearly increase of the incidence (P<0.05). During follow-up period no patient developed serious liver disease. Ultrasound examination revealed liver steatosis in 11% patients without HRT and in 9% of patients with HRT. The difference was not significant. No architectural changes, nor bile duct alterations have been noticed. There was no significant correlation between AST and BMI SDS R=0.09; P>0.05, ALT and age (R=0.02, P>0.05), nor AST and age (R=−0.01, P>0.05). Although there was significant correlation between ALT and BMI SDS (R=0.23, P<0.05), the relative risk of increased ALT and AST activity was not higher in obese patients (OR 0.2; 95%CI 0.1–0.36; P=0.38, and OR 0.16; 95%CI 0.08–0.3, P=0.1 respectively). HRT did not increase the risk of higher ALT and AST activity in girls with TS (OR 0.8; 95%CI 0.5–1.2; P=0.37, and OR 0.7; 95%CI 0.4–1.1, P=0.27 respectively).

Conclusions: Presence of obesity and HRT do not increase the relative the risk of higher ALT and AST activity. To explain clinical signficance of this phenomenon further longitudinal investigations are needed.

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