Turner’s syndrome

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Endometrial adenocarcinoma with Turner’s syndrome has been reported in young women on a regimen of exogenous estrogen since 1963.1–5 The Department of Gynecology became interested when one of us (JCS) saw a 23-year-old woman with a well-differentiated adenocarcinoma in 1977. This patient had been receiving estrogen for replacement therapy since age 16 when gonadal agenesis had been diagnosed.

The practical question emanating from this case was should these patients, without any symptoms of abnormal bleeding, be subjected to a yearly endometrial biopsy? This procedure has been advocated by various authors.5 A study was undertaken to answer this query.

Patients and methods

We reviewed the charts of patients with the diagnosis of Turner’s syndrome treated at the Cleveland Clinic from 1951 to 1975. The patients included in this study met the following criteria: (1) diagnosis of gonadal dysgenesis made by karyotype or Barr body analysis with physical stigmata of Turner’s syndrome and (2) use of estrogen (type of estrogen and dose varied) for at least 2 years after the diagnosis of Turner’s syndrome.

Usually, estrogen therapy had been prescribed for patients only after they were 13 years old, but was not usually prescribed if the diagnosis of gonadal agenesis was made after age 40.

Forty-three women fulfilled these criteria, and letters were sent to them requesting that they return for follow-up. Those who returned had pelvic examination, Pap smear with a sample obtained from the endocervix, and endometrial biopsy by Vabra aspiration in the office when technically possible.

Thirty-four women . . .



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