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      Avaliação da resistência insulínica e do perfil lipídico na síndrome de turner Translated title: Evaluation of insulin resistance and lipid profile in turner syndrome

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          OBJETIVO: Avaliar a presença de resistência insulínica (RI) e alterações lipídicas na síndrome de Turner (ST), correlacionando com idade, cariótipo, pressão arterial (PA), estatura, peso, índice de massa corporal (IMC) e desenvolvimento puberal. CASUÍSTICA E MÉTODO: Estudo transversal em 35 pacientes com ST confirmada pelo cariótipo (5 a 43 anos), sem uso prévio de anabolizantes ou hGH, avaliando PA, desenvolvimento puberal, antropometria, medidas de cintura (C) e quadril (Q), colesterol total, HDL, triglicérides (TGC), LDL, insulina e glicose. Foram calculados os índices de HOMA e QUICKI, e a relação glicose/insulina (G/I). Para a análise descritiva dos dados foram aplicados os testes de Mann-Whitney e Spearman. RESULTADOS: Dez pacientes tinham >20 anos. O cariótipo 45,X ocorreu em 17, e 6 com aberrações estruturais; não houve diferenças das variáveis em relação aos cariótipos. Quinze eram impúberes e 20 púberes; os TGC e o HOMA foram significativamente maiores na puberdade, e a G/I menor. Sete com estatura normal, 8 com IMC >25Kg/m2 (6 entre 25 e 30, e 2 >30), 19 com C/Q >0,85. O colesterol foi de 180 ± 42mg% (4 >240); o HDL de 57 ± 16mg%; o LDL de 99 ± 34mg%; os TGC de 108 ± 96mg% (2 >200); o HOMA de 1,01 ± 0,71; o QUICKI de 0,4 ± 0,04 e a G/I de 23,5 ± 12,1 (2 <7,0). CONCLUSÕES: Observaram-se alterações no perfil lipídico independentemente de faixa etária, cariótipo, PA e obesidade, porém agravadas pela RI, que foi menos freqüente do que descrita na literatura, parecendo relacionada à idade cronológica, obesidade e reposição estrogênica.

          Translated abstract

          OBJECTIVE: To evaluate the presence of insulin resistance (IR) and changes in lipid profile in Turner Syndrome (TS), and to check the influence of age, karyotype, systemic arterial hypertension (SAH), height, weight, body mass index (BMI), and pubertal development. PATIENTS AND METHODS: A transversal study of 35 TS patients, confirmed with karyotype (5 to 43 years), without previous use of anabolic steroid or hGH, with evaluation of blood pressure, pubertal development, anthropometric data, measurement of waist (W), hip (H), W to H ratio, total cholesterol, HDL, triglycerides (TGC), LDL, insulin and glucose. HOMA and QUICKI indexes were calculated, as well as glucose to insulin ratio (G/I). Data were examined by the Mann-Whitney and Spearman tests. RESULTS: Ten patients were >20 years. Seventeen had a 45,X karyotype and 6 structural aberrations; differences of the variables in relation to the karyotypes were not observed; 15 were nonpubertal and 20 pubertal; TGC and HOMA were significantly higher in puberty, while G/I was lower. Seven had normal height, 8 had BMI >25Kg/m2 (6 between 25 and 30, and 2 >30), and 19 W/H >0.85. Cholesterol levels were 180 ± 42mg% (4 >240); HDL 57 ± 16mg%; LDL 99 ± 34mg%; TGC 108 ± 96mg% (2 >200); HOMA 1.01 ± 0.71; QUICKI 0.4 ± 0.04 and G/I 23.5 ± 12.1 (2 <7.0). CONCLUSIONS: Changes were observed in lipid profile independent of age, karyotype, SAH and obesity, but associated with IR. The frequency of IR was lower than described in literature, and seems to be directly linked to chronological age, obesity and estrogen therapy.

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          Quantitative insulin sensitivity check index and the reciprocal index of homeostasis model assessment in normal range weight and moderately obese type 2 diabetic patients.

          To investigate whether the quantitative insulin sensitivity check index (QUICKI) and the reciprocal index of homeostasis model assessment (1/HOMA-IR) derived from fasting plasma glucose and insulin level are excellent surrogate indices of insulin resistance in both normal range-weight and moderately obese type 2 diabetic and healthy subjects. The association between QUICKI or 1/HOMA-IR and insulin resistance index assessed by euglycemic-hyperinsulinemic clamp (clamp-IR) was investigated in 121 type 2 diabetic and 29 healthy subjects recruited from among 120 (age 55 +/- 11, 48 +/- 15, and 52 +/- 15 years [means +/- SD], respectively). Type 2 diabetic subjects were divided into groups of 76 normal range-weight and 45 moderately obese subjects (BMI 21.4 +/- 2.3 vs. 27.2 +/- 2.2 kg/m(2), P < 0.0001). QUICKI and 1/HOMA-IR were significantly lower in the moderately obese group than in the normal range-weight type 2 diabetic and healthy groups (n = 120) (QUICKI, 0.338 +/- 0.030, 0.371 +/- 0.037, and 0.389 +/- 0.041, respectively, P < 0.0001; 1/HOMA-IR, 0.50 +/- 0.33, 0.92 +/- 0.55, and 1.24 +/- 0.82, P < 0.0001). QUICKI was strongly correlated with clamp-IR in normal range-weight, moderately obese type 2 diabetic, and healthy subjects (r = 0.641, 0.570, and 0.502, respectively; all subjects, r = 0.608, P < 0.01) and 1/HOMA-IR exhibited correlations comparable to those of QUICKI with clamp-IR (r = 0.637, 0.530, and 0.461, respectively; all subjects, r = 0.589, P < 0.001). In multiple regression models including QUICKI or 1/HOMA-IR as an independent variable, the estimation formula accounted for 55% of the variability of clamp-IR for the group of all type 2 diabetic subjects (R(2) = 0.547 and 0.551, respectively, P
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            Modified quantitative insulin sensitivity check index is better correlated to hyperinsulinemic glucose clamp than other fasting-based index of insulin sensitivity in different insulin-resistant states.

            Fasting-based index estimates of insulin sensitivity were compared with euglycemic hyperinsulinemic clamp (IS clamp) measurements in 148 subjects: normal controls (n = 46), and obese (n = 12), polycystic ovary syndrome (n = 16), first-degree relatives of type 2 diabetic (n = 17), impaired glucose tolerance (n = 28), and type 2 diabetic (n = 29) patients. The fasting-based indexes tested included log homeostasis model assessment (HOMA), the quantitative insulin sensitivity check index (QUICKI), the revised QUICKI, and a new revised QUICKI using fasting plasma glycerol. In the population studied, at 40 mU/m(2).min (n = 30) revised QUICKI (r = 0.86; P 0.80; P < 0.0001). When studied in subgroups, revised QUICKI and QUICKI-glycerol give significantly higher correlations with the IS clamp than other indexes for lean control subjects studied at 40mU/m(2).min and impaired glucose tolerance subjects. We confirmed, in a large patient population with a wide range of insulin sensitivities, that no single test is superior in all groups of patients. However, QUICKI and revised QUICKI are good indexes that offer correlations similar to or higher than values obtained with log HOMA. Such indexes are simple tools to estimate insulin sensitivity appropriate for epidemiological studies.
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              Comparison of Simple Measures of Insulin Sensitivity in Young Girls with Premature Adrenarche: The Fasting Glucose to Insulin Ratio May Be a Simple and Useful Measure

               M. Silfen (2001)

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                Arquivos Brasileiros de Endocrinologia & Metabologia
                Arq Bras Endocrinol Metab
                Sociedade Brasileira de Endocrinologia e Metabologia (São Paulo )
                April 2005
                : 49
                : 2
                : 278-285
                [1 ] Universidade Estadual de Campinas Brazil
                [2 ] Universidade Estadual de Campinas Brazil
                [3 ] Universidade Estadual de Campinas Brazil


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