Considerations for transition from paediatric to adult endocrinology: women with Turner's syndrome.
Turner's syndrome (TS) is a genetic anomaly that results from complete or partial absence of one X chromosome and is the most commonly occurring chromosomal abnormality in females. While most females with TS present at birth or in early childhood, nearly one quarter present at adult services with primary or secondary amenorrhoea. It is only with the advent of clinics dedicated to adults with TS that we have realised the degree of occult pathology present in this group. Adults with TS are thought to have a reduced life expectancy, mainly due to excess cardiovascular risk, but they may also have multiple comorbidities including hypothyroidism, deafness, osteoporosis and the attendant problems of oestrogen deficiency and infertility. Many of these features may be affected by the timing of treatments in paediatrics - particularly the timing of growth hormone (GH) and oestrogen use. It is the role of adult TS services to audit the outcome of TS and to inform their paediatric colleagues of the long-term effects of childhood treatments. Thus, a multidisciplinary approach to focused adult care is needed, with consideration of how to optimise surveillance strategies in these women.