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Li Y, Zhang T, Li P. Treatment of congenital adrenal hyperplasia and Klinefelter Syndrome with central precocious puberty: a case report. Transl Pediatr 2022; 11:298-305. [PMID: 35282026 PMCID: PMC8905097 DOI: 10.21037/tp-21-442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022] Open
Abstract
The simultaneous occurrence of Klinefelter syndrome (KS) and congenital adrenal hyperplasia (CAH) is extremely rare, as the former causes androgen deficiency, while the latter results in androgen excess. In addition, central precocious puberty (CPP) will occur, which is caused by the activation of the hypothalamic-pituitary-gonadal (HPG) axis by androgens. We present the 7th reported case of simultaneous KS and CAH in a boy with CPP due to protopathy of CAH. He presented with increased gonadotropin and excessive androgen levels, and was diagnosed with KS due to his unexpected karyotype analysis results. This is the first reported case of an association between KS and CAH to undergo gonadotropin-releasing hormone analog (GnRHa) and recombinant human growth hormone (rhGH) therapy to increase his predicted final height. His predicted adult height was approximately 160 cm by estimation using the bone age as well as current height, which is much taller than the estimated height before treatment. Although KS may cause hypogonadism, the patient should be administered GnRHa and rhGH therapy if simultaneous CAH, CPP, and KS are present to increase the patient's predicted final height. Excessive androgen levels may mask the symptoms of KS-related hypogonadism during childhood; however, the patient should be made aware of the possibility of hypogonadism developing in the future.
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Affiliation(s)
- Yan Li
- Department of Endocrinology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Zhang
- Department of Gastroenterology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Pin Li
- Department of Endocrinology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Maqdasy S, Barres B, Salaun G, Batisse-Lignier M, Pebrel-Richard C, Kwok KHM, Labbé A, Touraine P, Brugnon F, Tauveron I. Idiopathic central precocious puberty in a Klinefelter patient: highlights on gonadotropin levels and pathophysiology. Basic Clin Androl 2020; 30:19. [PMID: 33292161 PMCID: PMC7724694 DOI: 10.1186/s12610-020-00117-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/04/2020] [Indexed: 11/22/2022] Open
Abstract
Background Idiopathic central precocious puberty (ICPP) is supposed to be non-existent in a context of testicular destruction that is typically present in Klinefelter syndrome (KS). Herein, we describe a rare case of ICPP in a Klinefelter patient (47,XXY) with 2 maternal X chromosomes. Moreover, we highlight the differences in gonadotropin levels in comparison to males with ICPP and a normal karyotype. Case presentation An 8 years old boy with a history of cryptorchidism was evaluated for precocious puberty (Tanner staging: P2/G3). Both testes measured 25x35mm. His hormonal profile confirmed a central origin of precocious puberty with high serum testosterone (4.3 ng/ml), luteinizing hormone [LH (3.5 UI/l)] and follicle stimulating hormone [FSH (7.7 UI/l)] levels. Luteinizing hormone-releasing hormone (LHRH) test amplified LH and FSH secretion to 24 and 14 UI/l respectively. Brain magnetic resonance imaging (MRI) was normal. No MKRN3 mutation was detected. He was treated for ICPP for two years. During puberty, he suffered from hypergonadotropic hypogonadism leading to the diagnosis of KS (47,XXY karyotype). Chromosomal analysis by fluorescent multiplex polymerase chain reaction (PCR) using X chromosome microsatellite markers identified 2 maternal X chromosomes. Analysing 8 cases of KS developing ICPP (our reported case and 7 other published cases) revealed that these KS patients with ICPP have higher LH and FSH levels during ICPP episode than in ICPP patients with a normal karyotype (ICPP with KS vs ICPP with a normal karyotype: LH levels 9.4 ± 12 vs 1.1 ± 0.6 UI/l; FSH levels 23.1 ± 38.5 vs 2.7 ± 1.5 UI/l). Furthermore, their response to gonadotropin-releasing hormone (GnRH) stimulation is characterized by excessive LH and FSH secretion (LH levels post-GnRH: 58 ± 48 vs 15.5 ± 0.8 UI/l; FSH levels post-GnRH: 49.1 ± 62.1 vs 5.7 ± 3.9 UI/l). Conclusions ICPP in boys is extremely rare. The pathophysiology of ICPP in KS is unknown. However, maternal X supplementary chromosome and early testicular destruction may play a significant role in the initiation of ICPP, in part explaining the relative “overrepresentation of ICPP in KS. Thus, karyotype analysis could be considered for boys suffering from ICPP, especially if testicular size is smaller or gonadotropins are significantly elevated. Supplementary Information The online version contains supplementary material available at 10.1186/s12610-020-00117-1.
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Affiliation(s)
- Salwan Maqdasy
- CHU Clermont-Ferrand, Service d'endocrinologie, diabétologie et maladies métaboliques, 58, rue Montalembert, F-63003, Clermont-Ferrand, France. .,Université Clermont Auvergne, Faculté de médecine, F-63003, Clermont-Ferrand, France. .,Laboratoire GReD, Université Clermont Auvergne, F-63003, Clermont-Ferrand, France.
| | - Bertrand Barres
- Centre Jean Perrin, Service de Médecine nucléaire, F-63003, Clermont-Ferrand, France
| | - Gaelle Salaun
- CHU Clermont-Ferrand, service de cytogénétique médicale, F-63003, Clermont-Ferrand, France
| | - Marie Batisse-Lignier
- CHU Clermont-Ferrand, Service d'endocrinologie, diabétologie et maladies métaboliques, 58, rue Montalembert, F-63003, Clermont-Ferrand, France
| | - Celine Pebrel-Richard
- CHU Clermont-Ferrand, service de cytogénétique médicale, F-63003, Clermont-Ferrand, France
| | - Kelvin H M Kwok
- Department of Biosciences and Nutrition, Karolinska Institutet, 141 83, Stockholm, Sweden
| | - André Labbé
- CHU Clermont-Ferrand, Service de pédiatrie, F-63003, Clermont-Ferrand, France
| | - Philippe Touraine
- Hôpital Pitié-Salpêtrière, service d'endocrinologie et médecine de la reproduction, Centre de maladies endocriniennes rares de la croissance et du développement, Paris, France
| | - Florence Brugnon
- Université Clermont Auvergne, Faculté de médecine, F-63003, Clermont-Ferrand, France.,Assistance Médicale à la Procréation, CECOS, CHU Clermont-Ferrand, F-63000, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, CHU Clermont-Ferrand, F-63000, Clermont Ferrand, France
| | - Igor Tauveron
- CHU Clermont-Ferrand, Service d'endocrinologie, diabétologie et maladies métaboliques, 58, rue Montalembert, F-63003, Clermont-Ferrand, France.,Université Clermont Auvergne, Faculté de médecine, F-63003, Clermont-Ferrand, France.,Laboratoire GReD, Université Clermont Auvergne, F-63003, Clermont-Ferrand, France
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Gong C, Li L, Chen J, Li W. Central precocious puberty as a prelude to hypogonadism in a patient with Klinefelter syndrome. Pediatr Investig 2019; 3:127-130. [PMID: 32851304 PMCID: PMC7331432 DOI: 10.1002/ped4.12136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 04/16/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Incomplete pubertal development is a common phenomenon found in patients with Klinefelter syndrome (KFS). KFS combined with central precocious puberty (CPP) rarely occurs. We herein report a rare case of KFS with CPP and review several studies to determine the possible mechanism underlying this condition. CASE PRESENTATION An 8-year, 5-month-old male patient was admitted to our hospital because of enlargement of the penis and small testes. Laboratory evaluation revealed high luteinizing hormone and follicle-stimulating hormone levels, a high testosterone level, and the 48,XXYY karyotype. He was treated with triptorelin. One year later, the patient's testosterone level decreased and pubertal arrest occurred. CONCLUSION The literature review in this study showed that the occurrence of hypogonadism combined with CPP is not unique to patients with KFS; it has also been reported in individuals with Turner syndrome, adrenal hypoplasia congenita, and other diseases. Such individuals share common features including partial hypogonadism and a normal hypothalamic-pituitary-gonadal axis. CPP is considered a prelude to hypogonadism, and treatment with a gonadotropin-releasing hormone agonist may prevent gonadal failure.
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Affiliation(s)
- Chunxiu Gong
- Department of EndocrinologyGenetics, Metabolism and Adolescent MedicineBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Lele Li
- Department of EndocrinologyGenetics, Metabolism and Adolescent MedicineBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Jiahui Chen
- Department of EndocrinologyGenetics, Metabolism and Adolescent MedicineBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Wenjing Li
- Department of EndocrinologyGenetics, Metabolism and Adolescent MedicineBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
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Li L, Gong C. Central precocious puberty as a prelude of gonad dysplasia. Pediatr Investig 2019; 3:50-54. [PMID: 32851289 PMCID: PMC7331341 DOI: 10.1002/ped4.12118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 01/29/2019] [Indexed: 12/11/2022] Open
Abstract
There is increasing evidence that patients with gonad dysplasia, as characterized by absent or incomplete puberty, can also exhibit central precocious puberty (CPP). Herein, we review the reported cases that manifest with both gonad dysplasia and CPP. Further, we examine the hypothesis that these patients exhibit a normal hypothalamic-pituitary-gonadal axis, hypogonadism, and the presence of residual gonadal function, and that the onset of disease is related to early initiation of the hypothalamic-pituitary-gonadal axis. Thus, we suggest that CPP is a prelude of some partial hypogonadism.
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Affiliation(s)
- Lele Li
- Department of EndocrinologyGenetics, Metabolism and Adolescent MedicineBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Chunxiu Gong
- Department of EndocrinologyGenetics, Metabolism and Adolescent MedicineBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
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Nistal M, Paniagua R, González-Peramato P, Reyes-Múgica M. Perspectives in Pediatric Pathology, Chapter 16. Klinefelter Syndrome and Other Anomalies in X and Y Chromosomes. Clinical and Pathological Entities. Pediatr Dev Pathol 2016; 19:259-77. [PMID: 25105890 DOI: 10.2350/14-06-1512-pb.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Manuel Nistal
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo No. 2, Madrid 28029, Spain
| | - Ricardo Paniagua
- 2 Department of Cell Biology, Universidad de Alcala, Madrid, Spain
| | - Pilar González-Peramato
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo No. 2, Madrid 28029, Spain
| | - Miguel Reyes-Múgica
- 3 Department of Pathology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, One Children's Hospital Drive, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
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Mantovani V, Dondi E, Larizza D, Cisternino M, Bragliani M, Viggiani M, Martinetti M, Cuccia M. Do reduced levels of steroid 21-hydroxylase confer a survival advantage in fetuses affected by sex chromosome aberrations? Eur J Hum Genet 2002; 10:137-40. [PMID: 11938445 DOI: 10.1038/sj.ejhg.5200778] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2001] [Revised: 12/18/2001] [Accepted: 01/04/2002] [Indexed: 11/09/2022] Open
Abstract
We investigated whether molecular defects in the CYP21 gene were detectable in two common sex chromosome aberrations, the Turner and the Klinefelter syndromes. We found abnormal 17-hydroxyprogesterone levels after adrenal stimulation in 26/60 (43.3%) patients affected by these chromosome aberrations, as compared with only 11/68 (16.2%) normal controls (P=0.0014, odds ratio 4.0). Screening of the CYP21 gene identified a single Val281Leu missense mutation in exon 7 in 9/63 (14.3%) of the patients, all nine of whom were heterozygote carriers; the mutation frequency was significantly higher than in the general population (P=0.007, odds ratio=3.5). The hormonal and molecular data indicate that these common sex chromosome aberrations are associated with a remarkably high frequency of steroidogenic defects. It may be hypothesised that reduced levels of steroid 21-hydroxylase could confer a survival advantage, leading to a successful pregnancy.
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Affiliation(s)
- Vilma Mantovani
- Laboratorio Centralizzato Settore Genetica, Policlinico S.Orsola-Malpighi, Bologna, Italy.
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Grosso S, Anichini C, Berardi R, Balestri P, Pucci L, Morgese G. Central precocious puberty and abnormal chromosomal patterns. Endocr Pathol 2000; 11:69-75. [PMID: 15304841 DOI: 10.1385/ep:11:1:69] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Central precocious puberty (PP) can be caused by chromosomal aberrations. We report three patients presenting with central PP in whom karyotype analysis demonstrated abnormal chromosomal patterns. The first patient was affected by the triple-X syndrome, commonly characterized by premature ovarian failure. The second patient, a girl with inv dup(15)(pter-->q12::q12-->pter), had a chromosomal aberration involving an imprinted region of the human genome, whose deletion is commonly associated with Prader-Willi syndrome (PWS) and hypogonadotrophic hypogonadism. The third patient was a boy carrying a rare chromosome abnormality, the duplication of chromosome 9 (q22-->qter). All patients had mental retardation, which was mild in patient 1, moderate in patient 2, and severe in case 3. They underwent treatment with luteinizing hormone releasing hormone (LHRH) analogs, which were able to stop the progression of the sexual development. We confirm that chromosomal aberrations are an important cause of central PP, and that karyotype analysis in patients with PP and mental retardation, even if mild, is necessary because chromosomal abnormalities can be present.
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Affiliation(s)
- S Grosso
- Department of Pediatrics, University of Siena, Siena, Italy.
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Bertelloni S, Battini R, Baroncelli GI, Guerrini R, Viacava P, Spinelli C, Simi P. Central precocious puberty in 48,XXYY Klinefelter syndrome variant. J Pediatr Endocrinol Metab 1999; 12:459-65. [PMID: 10821227 DOI: 10.1515/jpem.1999.12.3.459] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report the first case of central precocious puberty in a patient with 48,XXYY Klinefelter syndrome variant. We also report clinical characteristics, growth pattern, endocrine data and pathological testicular findings. The patient did not receive medical care for his precocious pubertal development, because of adequate height prognosis, and reached normal height for both his target height and Klinefelter patients. Since precocious puberty seems to occur in Klinefelter syndrome and its variants, we advise karyotype analysis in boys with mental retardation, gynecomastia, small testes and precocious onset of puberty.
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Affiliation(s)
- S Bertelloni
- Department of Reproductive Medicine and Pediatrics, University of Pisa, Santa Chiara Hospital, Italy
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