A Recommended Approach to the Young Adult with Turner Syndrome Transitioning to Your Adult Endocrinology Practice
Background for Transition Visits
A team approach within the practice is recommended. Be sure that staff understands special situation of transition care.
The patient is not yet fully initiated into the "adult model" and may require assistance and support.
Parents should be allowed to attend appointments if the patient desires. It is recommended that the patient complete a Visitor Information Form to inform
a new provider who, if anyone, can attend appointments. Consider asking the patient to sign a form allowing the healthcare team to communicate with the patient’s parents.
Extra consideration in scheduling and confirming the appointment may be necessary.
The patient may also need assistance with:
The “unknown” of new facility (directions, parking issues)
What to bring to appointment:
Paperwork from former pediatric endocrinologist
Forms for the new physician (online, mailed)
List of medications or prescription bottles
The new healthcare team should greet the patient with the awareness that s/he is transferring care and provide support and assistance with the check-in process and paperwork.
Confirm contact information for the patient, ask about preferred name and how they prefer to be contacted (cell phone, text, email, depending on practice situation).
Consider developing a “Welcome to the Practice” guide that would provide this information to your new patient.
The First Encounter: Allow Ample Time
Review HIPAA and determine if parents/others are permitted to receive/hear information about the transitioning young adult.
Review contact information during office hours and for evenings/weekends in case questions arise.
Review clinical summary with patient or if patient transitioning without a summary from prior physician, cover the items on the clinical summary during history process.
Pay special attention to concerns about body image, reproductive issues, learning disabilities, fears, coping, family stressors.
Ask about any concerns or questions.
Ask about participation in Turner support network. Consider referral to local group if patient is not already participating.
Review other conditions or issues associated with Turner Syndrome. Identify the primary care physician or the specialist who will have primary responsibility for handling each concern.
Fertility and family planning
Hormone Replacement Therapy
Cardiovascular disease, hypertension
Depression, anxiety, and low-self esteem
Metabolic Syndrome, Diabetes risk
Metabolic bone disease
If there are multiple risk factors for aortic dissection, consider a wallet card or bracelet to alert medical personnel
Ongoing Monitoring (1)
Intervention || Frequency
Cardiology Evaluation (MRI, EKG) || At baseline, prior to pregnancy planning, every 5-10 years as indicated.
Blood pressure || Annually
ENT and Audiology || Every 1-5 yr
Fasting glucose, A1C, lipids, cbc, BUN/creatinine, vitamin D || Annually
DEXA scan || At initial visit and then as indicated