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Prevalence, Incidence, Diagnostic Delay, and Mortality in Turner Syndrome

Medical Department M (Endocrinology and Diabetes) (K.S., C.H.G.), Aarhus Sygehus NBG, Aarhus University Hospital, and Department of Epidemiology (S.J.), Institute of Public Health, Aarhus University, DK-8000C Aarhus, Denmark; National Institute of Public Health (K.J.), DK-1399K Copenhagen, Denmark; and Pediatric Department (R.W.N.), Randers Centralsygehus, DK-8900 Randers, Denmark

Address all correspondence and requests for reprints to: Claus Højbjerg Gravholt, M.D., Ph.D., Medical Department M (Endocrinology and Diabetes), Aarhus Sygehus, Nørrebrogade, Aarhus University Hospital, DK-8000 Aarhus C, Denmark. E-mail: ch.gravholt{at}dadlnet.dk.

Aim: Our aim was to study prevalence, incidence, age at diagnosis, and mortality in Turner syndrome (TS) in Denmark.

Methods: Using the Danish Cytogenetic Register, we identified all cases (n = 781) of TS alive in Denmark during 1970–2001. Sixty-nine deceased women with TS were identified in the Causes of Death Register. We divided the cohort into women having the karyotype 45,X, karyotypes including an isochromosome Xq, and all other karyotypes associated with TS. We describe the number of patients diagnosed in Denmark yearly, incidence rates, and the age at diagnosis. Standardized mortality ratios (SMR) were calculated.

Results: A total of 349 women had a 45,X karyotype, 86 had a karyotype including an isochromosome Xq (isoXq), and 346 had another TS karyotype. Mortality was increased in TS with an SMR of 2.86 (95% confidence interval, 2.18–3.55). SMR was increased for coronary diseases, congenital malformations, endocrine diseases, and other causes. The mortality was increased for all types of karyotypes in comparison with the general population but was highest among females with 45,X and isoXq. There was a steady increase in prevalence, but incidence was unchanged. Age at diagnosis was mainly distributed in three periods: less than 1 yr of age (14.9%), during adolescence (10–17 yr) (33.2%), and during adulthood (38.5%), with a median age at diagnosis of 15.1 yr, decreasing during the study period (P < 0.01).

Conclusions: Patients with TS and especially the karyotypes 45,X and isoXq have a higher mortality compared with the background population. TS was diagnosed with a considerable diagnostic delay. Prevalence is increasing, but incidence of TS was stable.

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