Prenatal sonographic diagnosis of the 49,XXXXY syndrome

Clinical spectrum of female genital malformations in prenatal diagnosis

Introduction

Fetal genital malformations represent a rare and heterogeneous group of congenital malformations of the disorders of sexual development (DSD) spectrum.

Methods

A thorough literature review on the main topics in the prenatal approach towards DSD was conducted.

Results

First, a thorough overview on prenatal characteristics of the most common fetal genital malformations of ovaries, uterus and external genitalia, and second, a standardized approach for differential diagnosis in the presence of direct and indirect prenatal signs of DSDs.

Conclusions

This review is mainly directed towards the aspects of female genital malformations with  aspects of male DSD explained as well to aid in the prenatal differential diagnosis.

Sexual and developmental aspects of 49, XXXXY Syndrome: A case report

49, XXXXY syndrome is one of the rarest sexual chromosome disorders, with an incidence of 1:85000-100000 males. It is caused by nondisjunction of the X chromosomes in both meiosis I and II. Early intervention is vital to improve behavioural, neural and sexual well-being. Information about sexual and developmental aspects is extremely limited in previous literature. We present a case of a 26-month-old male child presenting with hypotonia, micropenis and bilateral cryptorchidism. Karyotype study was done in Jordan at the age of 16 months and revealed 49, XXXXY syndrome. Global developmental delay, hypotonia and weak truncal muscles were noted on examination. Growth parameters were within normal limits. Kidney ultrasound revealed findings suggestive of Vesicoureteral reflux. Laboratory investigations revealed hypoandrogenism with normal 17-OHP levels. This study reviews current knowledge about sexual and developmental characteristics of 49, XXXXY syndrome.

Musculoskeletal abnormalities in a large international cohort of boys with 49,XXXXY

49,XXXXY is the rarest X and Y chromosomal variation, with an incidence of 1 in 80,000-100,000 live male births and has been associated with numerous musculoskeletal abnormalities. Data was collected from an international cohort of boys with 49,XXXXY over 10 years. Children were evaluated by a multidisciplinary team consisting of a pediatric orthopedist, a neurogeneticist, a neurodevelopmentalist, and two physical therapists. Increased rates of torticollis (32.4%), hamstring tightness (42%), radioulnar synostosis (67.6%), pes planus (65.2%), and other foot abnormalities (86.9%) were observed. Several anomalies increased with age, specifically hamstring tightness, kyphosis, and scoliosis. The elucidation of the orthopedic profile of this population is necessary in order to provide healthcare providers with current medical information. This research further supports the necessity for the comprehensive multidisciplinary treatment of boys with 49,XXXXY.

Close but not quite: Two cases of sex chromosome aneuploidies outside the scope of cell free DNA screening

WHAT'S ALREADY KNOWN ABOUT THIS TOPIC?

WHAT DOES THIS STUDY ADD?

Case report: 49, XXXXY syndrome and high myopia

49, XXXXY karyotype syndrome has been thought of as a variant of Klinefelter's syndrome. It has an incidence of between 1/85 000 to 1/100 000 live births. Typical clinical features include coarse faces, skeletal abnormalities, hypogenitalism and severe learning difficulties. Common ocular features include hypertelorism, epicanthic folds and up-slanting palpebral apertures. Here we report a case of high myopia and its successful correction leading to a positive personality change in one such patient. We advocate full ophthalmic examination, under anaesthesia if necessary, and a trial of refractive correction, even in children thought unlikely to tolerate such.