Some Turners stigmata, such as cubitus valgus and shortened fingers, are related to SHOX gene dosage effects.A number of the external manifestations of Turner syndrome are focused on the limbs, hands, and feet. Lymphedema at birth is one of the classic features of the syndrome; though it often resolves during toddlerhood, recurrence in later life is frequent, often without apparent cause. Cases where the retained X chromosome was inherited from the mother more often experience lymphedema than those where it was from the father. As a consequence of lymphedemas effects on nail anatomy, females with Turner syndrome frequently have small hypoplastic nails. Shortened metacarpal bones, particularly the fourth metacarpal, are a frequent finding. The body shape of individuals with Turner syndrome is frequently quite broad and stocky, as the growth deficiency is more pronounced in the length of bones than in their width. Scoliosis is common in Turner syndrome, and is seen in 40% of girls without growth hormone treatment.Facial features associated with Turner syndrome include prominent ears, a low hairline, a webbed neck, a small chin with dental malocclusion, and downslanting palpebral fissures (the opening between the eyelids). These are thought to be related to lymphedema during the fetal period, specifically to the presence and resorption of excess fluids in the head and neck region. Neck webbing is a particularly distinctive trait of Turner syndrome, leading to many neonatal diagnoses.
Drug-induced gingival enlargement (DIGE), also referred to as drug-induced gingival hyperplasia (DIGH) or drug-induced gingival overgrowth (DIGO), is a side effect of many systemic medications for which the Gingervae are not the target receptor. It is normally resultant of medications including immunoregulators, calcium channel blockers and anticonvulsants. When allowed to progress assisted by routinely poor oral hygiene, DIGE can lead to pain and disfigurement, however there are great variations in its presentation and severity dependent on the case. It is suggested that enlargement is aided by genetic predispositions, tending to occur more frequently in the papillae of the anterior Gingivae in younger age groups. Class of drugs
The main classes of drugs that result in gingivlal hyperplasia are as follows. Anticonvulsants
Anticonvulsant agents, such as phenytoin, are associated with common forms of gingival overgrowth. It is caused by the increase of metabolites from the break down of anticonvulsants in the body. It should also be noted that concurrent usage of different anticonvulsants in children has resulted in accumulative gingival enlargement. Immunosuppressive drugs
Immunoregulators are often prescribed to patients who have organ transplantations and/or some autoimmune diseases. Common immunosuppressive drugs linked to gingival hyperplasia are cyclosporin and tacrolimnus.The most frequently used immunosuppressive drug is cyclosporin, which is commonly prescribed after an organ transplant. Nearly 53% of patients taking cyclosporin after renal transplants presented with gingival growth. Inflammation from bacterial overgrowth in the gingiva and cyclosporins main metabolite, hydroxyciclosporin, stimulate production of collagen, while simultaneously inhibiting collagen breakdown — leading to a net increase in production of gingival tissues.