Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Describe the findings associated with Turner syndrome and consequent monitoring 2. Explain the recurrence risk to prospective parents
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Bicuspid aortic valve and coarctation of the aorta
Renal defects (i.e. horseshoe kidney)
Other findings may not be apparent until postnatal life
Short stature is usually the most consistent finding, approximately 8 inches less than what would be expected for her family
Genetic mechanism resulting in short stature still unknown, however the absence of the SHOX gene, located on short arm of X chromosome, which helps coordinate bone development, is likely an important factor
Wide or webbed neck
Low hairline at the back of the head
Broad chest with widely spaced nipples
Lymphedema, especially of the hands and feet
Absent, delayed, or partial spontaneous pubertal development (30%)
Absent or decreased fertility, depending on what percentage of cells have only one X chromosome, as two X chromosomes are required for ovarian development and function
Females who have a 45,X karyotype usually have normal intelligence although there may be some learning disabilities, particularly with mathematical and spatial concepts, some difficulty in social situations
Treatment and monitoring:
Growth hormone and hormone replacement therapy
Academic support for potential learning challenges
Turner syndrome (45,X) is a condition caused by an abnormal karyotype that is present at the time of conception and results from a sperm or egg that is capable of undergoing fertilization, but has no X chromosome. As this appears to be a random event, Turner syndrome is generally not inherited and risk of recurrence in subsequent pregnancies is minimal.
ACOG requires all women be offered prenatal screening (biochemical/ cfDNA) or invasive diagnostic testing (amniocentesis/ CVS)
Turner (45,X) syndrome is included on some cfDNA screening panels but is associated with a higher false positive rate compared to Down syndrome
Confirmatory testing (amniocentesis or CVS) should be offered all women with a positive cfDNA screening report
Presently, invasive testing is the only way to diagnose fetal Turner syndrome
There is data supporting the use of amniocentesis rather than CVS for confirmation
Present in 1/1500- 1/2500 live births
Estimated to account for 3% of all conceptions
Despite relatively functional outcomes, approximately 99% of cases are miscarried or stillborn
Mosaic Turner syndrome has a better chance of survival
ACMG provides ACT sheets to assist healthcare professionals with ‘next steps’ following a positive NIPS report for 45,X (see ‘Learn More – Primary Sources’ below)
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan