Elevated Liver Enzymes in Turner Syndrome: The Role of Low-grade Inflammation and Hormonal Imbalances

Lukas Ochsner Reynaud Ridder; Jesper Just; Christian Lodberg Hvas; Mette Mølby Nielsen; Holger Jon Møller; Henning Grønbæk; Claus H. Gravholt

doi:10.1210/jendso/bvaf059

Elevated Liver Enzymes in Turner Syndrome: The Role of Low-grade Inflammation and Hormonal Imbalances

Lukas Ochsner Reynaud Ridder^*, Jesper Just, Christian Lodberg Hvas, Mette Mølby Nielsen, Holger Jon Møller, Henning Grønbæk, Claus H. Gravholt

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Context: Turner syndrome (TS) is a chromosomal disorder in females characterized by the partial or complete absence of 1 X chromosome. Women with TS face a higher risk of liver disease, elevated enzymes and fibrosis, potentially linked to inflammation, and hormonal imbalances, though the cause remains unclear. Objective: This paper investigates the associations between liver parameters, inflammatory markers, and hormonal factors in women with TS compared with age-matched female controls. Methods: We included 82 women with TS and 59 female controls. Participants underwent clinical examinations, anthropometric measurements, and fasting biochemical assessments of liver enzymes (γ-glutamyl transferase [GGT], aspartate aminotransferase [AST], alanine aminotransferase [ALT], FIB-4), inflammatory markers (C-reactive protein [CRP], soluble CD163 [sCD163]), sex hormones, and 11-oxygenated C19 steroids. We also assessed myeloperoxidase (MPO) and neutrophil elastase gene expression levels and performed FibroScan and dual-energy X-ray absorptiometry. Results: Women with TS had higher levels of liver enzymes (GGT, AST, ALT) and FIB-4 than controls (P <. 001, all). The inflammatory markers CRP and sCD163 were both correlated with elevated liver parameters in women with TS. Hormonal variables such as 11β-hydroxytestosterone levels, were also associated with elevated liver enzymes in women with TS. The neutrophil activation marker MPO was elevated in TS and correlated with liver parameters and sCD163. Conclusion: Women with TS have elevated liver enzymes associated with low-grade chronic inflammation and hormonal imbalances. These findings highlight the importance of regular monitoring of liver function, inflammatory markers, and hormonal levels in women with TS to enable early intervention and potentially improve clinical outcomes.

Original language	English
Article number	bvaf059
Journal	Journal of the Endocrine Society
Volume	9
Issue	6
Number of pages	11
ISSN	2472-1972
DOIs	https://doi.org/10.1210/jendso/bvaf059
Publication status	Published - 1 Jun 2025

Keywords

inflammation
liver dysfunction
Turner syndrome

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10.1210/jendso/bvaf059Licence: CC BY-NC-ND

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@article{313754f52c484f339685778f6e3b243c,

title = "Elevated Liver Enzymes in Turner Syndrome: The Role of Low-grade Inflammation and Hormonal Imbalances",

abstract = "Context: Turner syndrome (TS) is a chromosomal disorder in females characterized by the partial or complete absence of 1 X chromosome. Women with TS face a higher risk of liver disease, elevated enzymes and fibrosis, potentially linked to inflammation, and hormonal imbalances, though the cause remains unclear. Objective: This paper investigates the associations between liver parameters, inflammatory markers, and hormonal factors in women with TS compared with age-matched female controls. Methods: We included 82 women with TS and 59 female controls. Participants underwent clinical examinations, anthropometric measurements, and fasting biochemical assessments of liver enzymes (γ-glutamyl transferase [GGT], aspartate aminotransferase [AST], alanine aminotransferase [ALT], FIB-4), inflammatory markers (C-reactive protein [CRP], soluble CD163 [sCD163]), sex hormones, and 11-oxygenated C19 steroids. We also assessed myeloperoxidase (MPO) and neutrophil elastase gene expression levels and performed FibroScan and dual-energy X-ray absorptiometry. Results: Women with TS had higher levels of liver enzymes (GGT, AST, ALT) and FIB-4 than controls (P <. 001, all). The inflammatory markers CRP and sCD163 were both correlated with elevated liver parameters in women with TS. Hormonal variables such as 11β-hydroxytestosterone levels, were also associated with elevated liver enzymes in women with TS. The neutrophil activation marker MPO was elevated in TS and correlated with liver parameters and sCD163. Conclusion: Women with TS have elevated liver enzymes associated with low-grade chronic inflammation and hormonal imbalances. These findings highlight the importance of regular monitoring of liver function, inflammatory markers, and hormonal levels in women with TS to enable early intervention and potentially improve clinical outcomes.",

keywords = "inflammation, liver dysfunction, Turner syndrome",

author = "Ridder, {Lukas Ochsner Reynaud} and Jesper Just and Hvas, {Christian Lodberg} and Nielsen, {Mette M{\o}lby} and M{\o}ller, {Holger Jon} and Henning Gr{\o}nb{\ae}k and Gravholt, {Claus H.}",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s).",

year = "2025",

month = jun,

day = "1",

doi = "10.1210/jendso/bvaf059",

language = "English",

volume = "9",

journal = "Journal of the Endocrine Society",

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Elevated Liver Enzymes in Turner Syndrome: The Role of Low-grade Inflammation and Hormonal Imbalances. / Ridder, Lukas Ochsner Reynaud ; Just, Jesper ; Hvas, Christian Lodberg et al.
In: Journal of the Endocrine Society, Vol. 9, No. 6, bvaf059, 01.06.2025.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Elevated Liver Enzymes in Turner Syndrome

T2 - The Role of Low-grade Inflammation and Hormonal Imbalances

AU - Ridder, Lukas Ochsner Reynaud

AU - Just, Jesper

AU - Hvas, Christian Lodberg

AU - Nielsen, Mette Mølby

AU - Møller, Holger Jon

AU - Grønbæk, Henning

AU - Gravholt, Claus H.

PY - 2025/6/1

Y1 - 2025/6/1

N2 - Context: Turner syndrome (TS) is a chromosomal disorder in females characterized by the partial or complete absence of 1 X chromosome. Women with TS face a higher risk of liver disease, elevated enzymes and fibrosis, potentially linked to inflammation, and hormonal imbalances, though the cause remains unclear. Objective: This paper investigates the associations between liver parameters, inflammatory markers, and hormonal factors in women with TS compared with age-matched female controls. Methods: We included 82 women with TS and 59 female controls. Participants underwent clinical examinations, anthropometric measurements, and fasting biochemical assessments of liver enzymes (γ-glutamyl transferase [GGT], aspartate aminotransferase [AST], alanine aminotransferase [ALT], FIB-4), inflammatory markers (C-reactive protein [CRP], soluble CD163 [sCD163]), sex hormones, and 11-oxygenated C19 steroids. We also assessed myeloperoxidase (MPO) and neutrophil elastase gene expression levels and performed FibroScan and dual-energy X-ray absorptiometry. Results: Women with TS had higher levels of liver enzymes (GGT, AST, ALT) and FIB-4 than controls (P <. 001, all). The inflammatory markers CRP and sCD163 were both correlated with elevated liver parameters in women with TS. Hormonal variables such as 11β-hydroxytestosterone levels, were also associated with elevated liver enzymes in women with TS. The neutrophil activation marker MPO was elevated in TS and correlated with liver parameters and sCD163. Conclusion: Women with TS have elevated liver enzymes associated with low-grade chronic inflammation and hormonal imbalances. These findings highlight the importance of regular monitoring of liver function, inflammatory markers, and hormonal levels in women with TS to enable early intervention and potentially improve clinical outcomes.

AB - Context: Turner syndrome (TS) is a chromosomal disorder in females characterized by the partial or complete absence of 1 X chromosome. Women with TS face a higher risk of liver disease, elevated enzymes and fibrosis, potentially linked to inflammation, and hormonal imbalances, though the cause remains unclear. Objective: This paper investigates the associations between liver parameters, inflammatory markers, and hormonal factors in women with TS compared with age-matched female controls. Methods: We included 82 women with TS and 59 female controls. Participants underwent clinical examinations, anthropometric measurements, and fasting biochemical assessments of liver enzymes (γ-glutamyl transferase [GGT], aspartate aminotransferase [AST], alanine aminotransferase [ALT], FIB-4), inflammatory markers (C-reactive protein [CRP], soluble CD163 [sCD163]), sex hormones, and 11-oxygenated C19 steroids. We also assessed myeloperoxidase (MPO) and neutrophil elastase gene expression levels and performed FibroScan and dual-energy X-ray absorptiometry. Results: Women with TS had higher levels of liver enzymes (GGT, AST, ALT) and FIB-4 than controls (P <. 001, all). The inflammatory markers CRP and sCD163 were both correlated with elevated liver parameters in women with TS. Hormonal variables such as 11β-hydroxytestosterone levels, were also associated with elevated liver enzymes in women with TS. The neutrophil activation marker MPO was elevated in TS and correlated with liver parameters and sCD163. Conclusion: Women with TS have elevated liver enzymes associated with low-grade chronic inflammation and hormonal imbalances. These findings highlight the importance of regular monitoring of liver function, inflammatory markers, and hormonal levels in women with TS to enable early intervention and potentially improve clinical outcomes.

KW - inflammation

KW - liver dysfunction

KW - Turner syndrome

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U2 - 10.1210/jendso/bvaf059

DO - 10.1210/jendso/bvaf059

M3 - Journal article

C2 - 40297608

AN - SCOPUS:105003972970

SN - 2472-1972

VL - 9

JO - Journal of the Endocrine Society

JF - Journal of the Endocrine Society

IS - 6

M1 - bvaf059

ER -

Elevated Liver Enzymes in Turner Syndrome: The Role of Low-grade Inflammation and Hormonal Imbalances

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