Obesity Abstracts

Introduction: Turner Syndrome (TS) is linked to obesity, metabolic dysfunction associated steatotic liver disease (MASLD), hypertension, type 2 diabetes, cardiovascular disease, and psychiatric comorbidities, complicating care. Although no large trials have assessed GLP-1 receptor agonists (RAs) specifically in TS, evidence from obesity and MASLD populations suggests they may enhance satiety, reduce emotional eating, and support sustained weight loss—leading to improved cardiometabolic health. While off-label, GLP-1 RAs represent a promising therapeutic option for TS patients with metabolic dysfunction, further research is needed to clarify potential risks, duration of therapy, and strategies for maintaining metabolic benefits after discontinuation.

Case: A 31-year-old woman with Turner syndrome (TS) and longstanding obesity (BMI 54 kg/m²) was reviewed in the specialist weight management clinic. Her complex comorbidities included MASLD, congenital sensorineural hearing loss, glaucoma, emotional eating disorder, and obsessive-compulsive disorder. Multiple lifestyle interventions had previously proven unsustainable, and she elected to self-fund GLP-1 receptor agonist therapy with semaglutide, titrated to 2.4 mg weekly. Treatment resulted in a dramatic reduction in BMI from 54 to 18.9 over approximately 8 months, corresponding to an 86 kg weight loss. Liver function improved, with ALT falling from 248 to 142 IU/l and ALP from 175 to 98 IU/l, while lipid profile also improved with total cholesterol decreasing from 6.8 to 5.9 mmol/l. Ultrasound confirmed fatty liver changes. Psychologically, she reported a marked reduction in intrusive food-related thoughts and cravings, although a persistent tendency toward emotional eating remained a concern.

Conclusion: In this case, GLP-1 RA demonstrated remarkable efficacy in a patient with TS, obesity, and multiple cardiometabolic comorbidities. The complexity of such cases underscores the importance of management within a specialist, multidisciplinary service that offers integrated care pathways to optimise outcomes. Discontinuing GLP-1 therapy after weight loss is challenging due to rebound weight gain driven by physiological counter-regulation and renewed appetite. To minimise relapse, withdrawal should be gradual and supported by strong behavioural/psychological strategies alongside cardiometabolic monitoring. However, the long-term safety and durability of GLP-1 therapy in patients with Turner’s syndrome remain insufficiently studied.