Introduction
Methods
Results
No | Statement | Rating |
---|---|---|
Working subgroup A: transition and referral | ||
A1 | If possible, TS patients should be transitioned from pediatric to adult endocrinologist at the age of 18 years | 1/++0 |
A2 | The appropriate age could differ depending on the readiness of each patient | 1/++0 |
A3 | A validated assessment questionnaire should be used to evaluate transition readiness in TS patients | 1/++0 |
A4 | To ensure that patients with TS are physically fit for transition, milestones for the health management in adulthood should have been achieved | 1/++0 |
A5 | Adolescent patients with TS should be informed about all aspects of the syndrome during adult life, including the risk of complications and the need for regular follow-up and preventive healthcare | 1/++0 |
A6 | Before transition, patients' and caregivers' knowledge about TS should be reviewed, including the need and willingness for any additional education, which should be personalized | 1/++0 |
A7 | During the transition process, telemedicine can enhance communication and the sharing of information and increase flexibility in visit scheduling | 2/+00 |
A8 | Ideally, transition to adult care for TS patients should take place at the same hospital where the patient was treated by a pediatrician in the setting of a multidisciplinary team | 1/++0 |
A9 | A medical record summary containing essential TS-specific clinical information is necessary during transition from the care of pediatric to adult endocrinologist | 1/++0 |
A10 | The first transition visit should be managed by both pediatric and adult endocrinologists as an opportunity to ensure a continuity of care and to establish a comprehensive care plan | 1/++0 |
Working subgroup B: sexual and bone health and oncological risk | ||
B1 | Most girls with TS require HRT, initially for the induction of puberty and later for maintaining secondary sex characteristics, attaining peak bone mass and normalizing uterine growth for possible pregnancy | 1/++0 |
B2 | Transdermal preparations of ERT are the preferred regimen in girls with TS | 1/+00 |
B3 | Girls with TS typically have a normal uterus, and progestin/progesterone must be added once breakthrough bleeding occurs or after 2 years of ERT | 1/+00 |
B4 | During transition, or before the transition process begins, individuals with TS should be counseled that their ability to conceive spontaneously decreases rapidly with age and may not be present during adulthood and that spontaneous pregnancies are rare | 1/+++ |
B5 | Fertility assessment should be performed between the age of 12 and 14 years; the best procedure for preserving fertility in young women with TS and persistent ovarian function is oocyte or embryo cryopreservation | 2/+00 |
B6 | Osteopenia and osteoporosis are common features in young women with TS, with an estimated prevalence of 50% and an increased risk of early bone fractures | 1/++0 |
B7 | ERT is essential for the maintenance of bone health in TS, and early initiation is one of the most important determinants of bone health | 1/+++ |
B8 | Transdermal estrogens appear to have more beneficial effects on bone mass than oral preparations | 2/+00 |
B9 | Although overall oncologic risk in TS is similar or slightly higher compared with the general population, particular attention should be paid to the monitoring for specific tumors, such as thyroid carcinoma, meningioma and skin tumors | 1/+00 |
B10 | Individuals with a Y chromosome may be at risk of gonadoblastoma, therefore gonadectomy should be discussed with these patients and their caregivers, taking into account the balance of the risks and benefits of the procedure | 2/+00 |
Working subgroup C: social and psychological aspects | ||
C1 | For an effective transition process, direct involvement of the patient with TS in the treatment path is essential | 1/++0 |
C2 | TS is associated with the presence of a characteristic neurocognitive profile that can influence the long-term adaptive and social functioning and the acquisition of full autonomy | 1/++0 |
C3 | TS is associated with psychiatric disorders, including a significantly elevated risk of anxiety and depression in adolescents and young adults | 1/++0 |
C4 | Anxiety and depression interfere with the psychological health and function of patients with TS | 1/++0 |
C5 | A periodic neuropsychological assessment during the age of development is needed to prevent the occurrence or worsening of psychopathological problems later in life | 1/++0 |
C6 | Psychodiagnostic assessment should be reinforced in adolescence and at the age of transition in patients with TS | 1/++0 |
C7 | Sexuality-related attitudes and behaviors of adolescents with TS should be discussed before the transition to adult care to ensure greater psycho-relational well-being | 1/++0 |
C8 | Adolescents and young women with TS have a lower QoL than the general population, with a marked impairment in psychosocial variables, although generally their socioeconomic status does not seem to be impaired | 1/++0 |
C9 | Since eating disorders are more frequent in adolescents with TS compared with the general population, this issue should be proactively investigated | 1/++0 |
Working subgroup D: systemic and metabolic disorders | ||
D1 | In young women, screening for DM using HbA1c and FPG is recommended annually, and with OGTT every two years, regardless of BMI, family history, karyotype, previous therapy with recombinant GH and therapy with estrogens/progestins | 1/++0 |
D2 | BMI is not sufficiently reliable to identify TS subjects with obesity, therefore waist circumference, waist-to-height ratio and body composition assessment are recommended annually | 1/++0 |
D3 | Annual screening for liver function tests is recommended, and liver ultrasound should be performed if they are markedly and persistently altered. HRT should not be interrupted because of liver dysfunction | 1/++0 |
D4 | At least one ambulatory BP assessment per year is required and, at the first diagnosis of hypertension, secondary causes must be excluded. It is reasonable that Holter BP measurement is performed at least once | 1/+++ |
D5 | As antihypertensive drugs β-blockers, ARBs or ACE-I should be used in first-line treatment. In addition, losartan may be effective in reducing aortic growth velocity | 2/+00 |
D6 | During transition, TTE or cardiac magnetic resonance CMR assessment studies should be performed and tailored to each patient in case of structural heart disease | 1/++0 |
D7 | Patients' awareness of the risk of aortic dissections and the early recognition of symptoms are essential | 1/++0 |
D8 | Surgical management of the aortic root and ascending aorta is recommended for women with TS aged ≥ 15 years, ascending ASI ≥ 25 mm/m2, regardless of the presence of risk factors for aortic dissection | 2/++0 |
D9 | The assessment of anti-TPO antibodies is recommended annually, until positive results. The assessment of TSH ± FT4 is recommended annually, regardless of the presence of Hashimoto’s thyroiditis or L-thyroxine replacement therapy | 1/+++ |
D10 | At transition, thyroid ultrasound should be performed and repeated every two years in cases of altered thyroid function or positive Anti-TPO Ab, or annually in case of thyroid nodules and/or goiters | 2/++0 |
D11 | Screening for celiac disease should be performed once every 3 years or earlier in case of clinical suspicion. Autoimmunity screening for the other diseases should be performed only in case of clinical suspicion | 1/++0 |
D12 | Audiologic and sensorineural screening should be periodically performed in all patients to monitor hearing loss and other complications, and to guarantee psychosocial integration and improved QoL | 1/++0 |