Endocrine Abstracts

Introduction: Turner Syndrome is a chromosomal disorder that is characterized by short stature and gonadal dysgenesis, affecting 1 in 2500 female live births. It is associated with a wide variety of conditions that could lead to significant morbidity and mortality if not followed up and managed appropriately. A multidisciplinary approach is important in the management of these patients. This audit aims to review the current practice of a specialist Turners Syndrome clinic in a secondary care hospital (Nottingham University Hospital, England) and to assess if standards of care are met.

Methods: A retrospective study of 37 patients who attended the clinic from Jan 2015 to Jan 2016 was done. Criteria based on two international guidelines were used. Information was gathered from local computer system which held tests reports and clinic letters.

Results: Median age of patients was 27 years old (range: 18–48). Areas well monitored (>85%) were bone health (with DEXA scan), U&E, LFT, VitD, calcium levels and the type of hormone therapy used. Areas less well monitored (50–85%) were thyroid function, coeliac screening, diabetes screening, ECHO and renal ultrasound. Areas that needed significant improvement (<50%) were audiology, lipid, FSH and LH level monitoring. 4 patients had an abnormal ECHO but only 1 went on to have an MRI. Only 24.3% of patients had a cardiac MRI. A majority of patients were on HRT (94.6%) but only 11.4% was on a transdermal form.

Conclusions: The audit showed varying performance in different areas. A standardized checklist and patient booklet for each patient review will be introduced to help identify tests due and to allow easy access to results that may have been done at another location. We would also consider doing more cardiac MRIs to pick up cardiac abnormalities that may have been missed on ECHO and to offer patients a switch from oral to transdermal HRT which is known to be more physiological.