Can individuals with Turner's syndrome take Mounjaro (tirzepatide)?

Mounjaro (Tirzepatide) Use in Turner Syndrome

Individuals with Turner syndrome can safely take Mounjaro (tirzepatide), but require careful cardiovascular assessment and monitoring due to their increased risk of aortic complications. 1

Cardiovascular Assessment Before Starting Mounjaro

Turner syndrome patients have significant cardiovascular risks that should be evaluated before initiating any new medication:

• Mandatory baseline tests:

  • Transthoracic echocardiography (TTE)
  • Cardiac MRI
  • Calculation of Aortic Size Index (ASI) for patients ≥15 years old 1

• Risk stratification:

  • High risk: ASI ≥2.5 cm/m², history of aortic coarctation, or uncontrolled hypertension
  • Moderate risk: ASI 2.0-2.3 cm/m² or AHI 2.0-2.3 cm/m
  • Low risk: ASI <2.0 cm/m² or AHI <2.0 cm/m 2, 1

Monitoring Requirements

Monitoring frequency should be based on cardiovascular risk:

• Low risk: Cardiology evaluation and TTE every 5-10 years
• Moderate risk: Cardiology evaluation and TTE every 3-5 years
• High risk: Annual cardiology evaluation and TTE 2, 1

Regular blood pressure monitoring is essential as hypertension is a significant risk factor for aortic complications in Turner syndrome patients 1.

Special Considerations for Mounjaro in Turner Syndrome

1. Metabolic benefits: Turner syndrome patients have increased risk of type 2 diabetes, making Mounjaro potentially beneficial for those with metabolic issues 1, 3

2. Medication interactions: No known significant interactions between Mounjaro and standard hormone replacement therapy (HRT) commonly used in Turner syndrome 1

3. Blood pressure effects: Mounjaro may have modest blood pressure-lowering effects, which could be beneficial as hypertension is common in Turner syndrome 1

4. Gastrointestinal side effects: Standard Mounjaro side effects (nausea, vomiting, diarrhea) should be monitored, particularly in patients with inflammatory bowel disease or celiac disease, which are more common in Turner syndrome 4

Warning Signs Requiring Immediate Attention

Any Turner syndrome patient on Mounjaro experiencing sudden, severe chest or abdominal pain should be immediately evaluated for aortic dissection, with:

• Immediate transfer to emergency department
• Strict blood pressure control
• Surgical consultation if ASI ≥2.5 cm/m² with risk factors 1

Practical Algorithm for Mounjaro Use in Turner Syndrome

1. Pre-treatment assessment:

   • Confirm Turner syndrome diagnosis with karyotype analysis
   • Complete cardiovascular assessment (TTE, cardiac MRI, ASI calculation)
   • Establish baseline blood pressure and metabolic parameters

2. Risk-based decision making:

   • Low/moderate risk: Standard Mounjaro dosing protocol
   • High risk: Consider cardiology consultation before initiating Mounjaro

3. Monitoring during treatment:

   • Follow standard Mounjaro titration schedule
   • Monitor blood pressure at each visit
   • Continue risk-appropriate cardiovascular surveillance
   • Maintain hormone replacement therapy as prescribed

Common Pitfalls to Avoid

1. Neglecting cardiovascular assessment: Never initiate Mounjaro without baseline cardiovascular evaluation in Turner syndrome patients

2. Inadequate monitoring: Ensure proper transition from pediatric to adult care to maintain lifelong surveillance 1

3. Missing warning signs: Any unusual chest or abdominal pain should prompt immediate evaluation for aortic complications

4. Overlooking comorbidities: Turner syndrome patients have increased risk of autoimmune disorders, osteoporosis, and hearing impairment that may require additional monitoring 4, 5

By following these guidelines, Mounjaro can be safely prescribed to individuals with Turner syndrome while appropriately managing their unique cardiovascular risks.