Fibroscan: a new non-invasive method for evaluation of liver dysfunction in Turner syndrome

Background Raised liver enzyme value is frequently detected in patients with Turner syndrome (TS), but its clinical importance is still unclear. Objective To investigate the entity of liver involvement in TS and to avoid the invasiveness of liver biopsy, we planned to measure liver stiffness by transient elastography (TE). Design Cross-sectional study. Patients and methods Twenty-five consecutive patients with TS and a chronological age ‡ 12Æ5 years (mean age = 21Æ7 years), full pubertal development and final height’s achievement were enrolled and investigated by blood biochemical analyses [glucose, insulin, aspartate-aminotransferase (AST), alanine-aminotransferase (ALT), gamma-glutamil transferase (GGT), alkaline phosphatase, cholesterol, triglyceride, HDL-cholesterol], ultrasonography and TE of the liver. Results Of 25, 7 subjects (28%) showed liver enzyme levels higher than the normal upper limit. Mean liver stiffness value in the entire study group was 4Æ5 ± 1Æ7 kPa, being significantly higher in patients with abnormal liver enzymes than in those with normal liver biochemistry (6Æ0 ± 2Æ9 vs. 4Æ0 ± 0Æ9, P < 0Æ05). Strong correlations were found between TE values and ALT (P < 0Æ005), GGT (P < 0Æ0001), Body mass index (P < 0Æ05), HOMA index (P < 0Æ05), HDL-cholesterol (P < 0Æ05) and triglycerides (P < 0Æ0001). Conclusions We can assert that (i) liver stiffness, measured by TE, strongly correlates with liver enzyme levels in patients with TS ; (ii) the increased liver stiffness in patients with TS with biochemical signs of liver dysfunction is significantly related to metabolic syndrome parameters; (iii) TE may be an useful tool to select among patients with TS with elevated liver enzymes or other metabolic risk factors, those who deserve more invasive diagnostic procedures, namely liver biopsy, for the best characterisation of liver damage.