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Wu Z, Bao L, Wang H, Zheng J, Chen Y, Wang W, Qiu D. Association between weight-adjusted waist index and serum total testosterone in males aged 6-19 years in the United States: Data from NHANES 2013-2016. Heliyon 2024; 10:e27520. [PMID: 38496858 PMCID: PMC10944222 DOI: 10.1016/j.heliyon.2024.e27520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 02/24/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024] Open
Abstract
Objective This study aimed to estimate the association between weight-adjusted waist index and serum total testosterone (sTT) in males aged 6-19 years in the United States. Methods A cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey (NHANES) 2013-2016. sTT was considered as the response variable, and weight-adjusted waist circumference index (WWI) as the independent variable. Multiple linear regression was performed to estimate the association between the two variables, and subgroup analysis was performed to identify sensitive cohorts. Smoothing curve fitting and threshold effects analysis was carried out to assess possible nonlinear relationships between WWI and sTT. Results The study included 4207 participants. The mean value of sTT (117.93 ng/dl) was used as the grouping basis, with 1066 participants having serum total testosterone levels above the mean. A negative association was observed between WWI and sTT [beta coefficient (β) = -72.50, 95% confidence interval (CI): -79.45, -65.55], which decreased as WWI increased (P for trend<0.05). Subgroup analysis indicated a stronger negative correlation in late adolescent (16-19 years) males (β = -128.94, 95% CI: -146.75, -111.13). The smoothing curve fit analysis revealed a U-shaped curve relationship for the negative correlation between WWI and sTT. Threshold effect analysis suggested a significant change when WWI exceeded 10.09 (β = -15.82, 95% CI: -24.11, -7.54), and stepwise threshold effect analysis indicated that this negative correlation became less stable when WWI exceeded 11.45 (β = -0.80, 95% CI: -9.15, 7.56). Conclusions Participants with higher WWI exhibited lower total testosterone levels, and a negative association was found between WWI and total testosterone, particularly in late adolescent males aged 16-19 years. Among males aged 6-19 years, caution should be exercised regarding the risk of lower testosterone levels associated with elevated WWI, particularly when WWI is below 10.09.
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Affiliation(s)
- Zhifei Wu
- Department of Pediatrics, Beilun District People's Hospital, Ningbo City, Zhejiang Province, PR China
| | - Lingling Bao
- Beilun District People's Hospital, Ningbo City, Zhejiang Province, PR China
| | - Haiyan Wang
- Department of Pediatrics, Beilun District People's Hospital, Ningbo City, Zhejiang Province, PR China
| | - Jiajing Zheng
- Department of Pediatrics, Beilun District People's Hospital, Ningbo City, Zhejiang Province, PR China
| | - Yu Chen
- Department of Pediatrics, Beilun District People's Hospital, Ningbo City, Zhejiang Province, PR China
| | - Wenjuan Wang
- Beilun District People's Hospital, Ningbo City, Zhejiang Province, PR China
| | - Dongkai Qiu
- Department of Pediatrics, Beilun District People's Hospital, Ningbo City, Zhejiang Province, PR China
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2
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Ahlawat N, Elliott K, Ormond KE, Allyse MA, Riggan KA. Healthcare and support experiences of adolescents and young adults diagnosed with 47,XXY, 47,XXX, and 48,XXYY. J Community Genet 2024; 15:75-83. [PMID: 37864743 PMCID: PMC10857988 DOI: 10.1007/s12687-023-00682-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/06/2023] [Indexed: 10/23/2023] Open
Abstract
Sex chromosome aneuploidies (SCAs) are among the most common chromosomal conditions. There is little scholarship on how adolescents and young adults (AYAs) affected by SCA engage with and adapt to their diagnosis. In order to understand how AYAs adapt to a SCA diagnosis, we conducted a secondary analysis of qualitative interviews with AYAs. Eight in-depth semi-structured interviews with individuals with a diagnosis of 47,XXY, 47,XXX, and 48,XXYY were analyzed for iterative themes related to adaptation to a SCA diagnosis in accordance with standard qualitative methodology. Our findings suggest that the process of adaptation is highly variable and complex and is mediated by external factors including diagnosis delivery and community support. Factors associated with adaptation include feeling understood and supported by healthcare providers; researching the condition; receiving hormone replacement therapy; and receiving support from a community of peers. As access to prenatal and pediatric genetic testing continues to expand, non-genetic pediatric providers are increasingly likely to interact with individuals with SCAs as part of their initial diagnostic odyssey or ongoing medical management. Understanding the diversity of lived experiences of AYAs with SCAs is helpful for healthcare providers to facilitate holistic care and provide meaningful support to patients.
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Affiliation(s)
- Nivedita Ahlawat
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Verily Life Sciences, San Francisco, CA, USA
| | - Kathryn Elliott
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Kaiser Permanente San Francisco, San Francisco, CA, USA
| | - Kelly E Ormond
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Megan A Allyse
- Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
- Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
- Biomedical Ethics Research Program, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA.
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3
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Butler G, Srirangalingam U, Faithfull J, Sangster P, Senniappan S, Mitchell R. Klinefelter syndrome: going beyond the diagnosis. Arch Dis Child 2023; 108:166-171. [PMID: 35948402 PMCID: PMC7614197 DOI: 10.1136/archdischild-2020-320831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/14/2022] [Indexed: 11/04/2022]
Abstract
Although Klinefelter syndrome (KS) is common, it is rarely recognised in childhood, sometimes being identified with speech or developmental delay or incidental antenatal diagnosis. The only regular feature is testicular dysfunction. Postnatal gonadotropin surge (mini-puberty) may be lower, but treatment with testosterone needs prospective studies. The onset of puberty is at the normal age and biochemical hypogonadism does not typically occur until late puberty. Testosterone supplementation can be considered then or earlier for clinical hypogonadism. The size at birth is normal, but growth acceleration is more rapid in early and mid-childhood, with adult height greater than mid-parental height. Extreme tall stature is unusual. The incidence of adolescent gynaecomastia (35.6%) is not increased compared with typically developing boys and can be reduced or resolved by testosterone supplementation, potentially preventing the need for surgery. Around two-thirds require speech and language therapy or developmental support and early institution of therapy is important. Provision of psychological support may be helpful in ameliorating these experiences and provide opportunities to develop strategies to recognise, process and express feelings and thoughts. Boys with KS are at increased risk of impairment in social cognition and less accurate perceptions of social emotional cues. The concept of likely fertility problems needs introduction alongside regular reviews of puberty and sexual function in adolescents. Although there is now greater success in harvesting sperm through techniques such as testicular sperm extraction, it is more successful in later than in early adolescence. In vitro maturation of germ cells is still experimental.
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Affiliation(s)
- Gary Butler
- Paediatric and Adolescent Endocrinology, University College London Hospitals NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Jennie Faithfull
- Endocrinology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Philippa Sangster
- Urology and Andrology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Rod Mitchell
- MRC Centre for Reproductive Health, University of Edinburgh Division of Reproductive and Developmental Sciences, Edinburgh, UK
- Department of Diabetes and Endocrinology, Royal Hospital for Sick Children, Edinburgh, UK
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4
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Riggan KA, Gross B, Close S, Steinberg A, Allyse MA. "Knowledge is Power": Parent Views on the Benefits of Early Diagnosis and Awareness of Sex Chromosome Multisomy Among Pediatric Professionals. J Dev Behav Pediatr 2023; 44:e119-e125. [PMID: 36454640 PMCID: PMC10117700 DOI: 10.1097/dbp.0000000000001153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/04/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE Pediatric diagnoses of sex chromosome multisomies (SCMs) have increased as genetic testing has expanded. However, depending on SCM presentation, there may be significant delays between symptom recognition and diagnosis. We conducted a survey of parents of children diagnosed with SCMs to understand their experiences receiving an SCM diagnosis and their support needs. METHODS We conducted an inductive qualitative analysis of open-ended survey responses for iterative themes related to presenting symptoms, diagnostic odyssey, immediate and long-term support needs, and awareness of SCMs. RESULTS Of the 323 parents who completed the survey, 185 parents received a pediatric diagnosis (0-21 years) in a child. Many parents expressed feelings of relief when receiving the diagnosis, especially if it occurred after a lengthy diagnostic odyssey. Parents reported frustration that their child's nonmedical symptoms, including learning disabilities, speech delays, attention deficits, and behavioral issues, were not flagged as potential indications for SCMs and suggested that greater awareness of SCMs by pediatricians, educators, and other professionals involved in their child's care may lead to earlier diagnosis and intervention. CONCLUSION This is the largest qualitative study to date examining parent and caregiver experiences with a pediatric diagnosis of SCMs. Increased knowledge and awareness of nonmedical SCM symptoms are needed among medical, education, occupational, and psychology professionals for early testing referral and improved support of children with SCMs.
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Affiliation(s)
| | - Brianna Gross
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sharron Close
- Nell Hodgson Woodruff School of Nursing, Emory University Atlanta, GA
| | | | - Megan A. Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
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Simonetti L, da Silva MRD, de Mello CB. Educational status, testosterone replacement, and intelligence outcomes in Klinefelter syndrome. Dement Neuropsychol 2022; 16:97-104. [PMID: 35719264 PMCID: PMC9170263 DOI: 10.1590/1980-5764-dn-2021-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/27/2021] [Accepted: 10/03/2021] [Indexed: 11/22/2022] Open
Abstract
Most male hypergonadotropic hypogonadism associated with infertility can be attributed to a single genetic condition such as Klinefelter syndrome (KS). This disease's wide phenotypic variability is frequently associated with mosaic 47,XXY lineages and testosterone replacement. Early diagnosis and treatment have been associated with better cognitive and intellectual outcomes, but the scope of this influence requires further investigation. Objective This study aimed to investigate the intelligence profile of a cohort of patients with KS, considering the influence of educational level and clinical variables. Methods Twenty-nine (9-65 years) individuals were submitted to the measures of intelligence quotient (IQ) (Wechsler's Scales) and adaptive behavior (Vineland-II). Linear regression analysis included the participants' educational level and clinical variables (i.e., comorbidities and use of testosterone) as predictors and intellectual performance and adaptive behavior as outcomes. Results Scores varied from intellectual deficiency to average ranges (82.5+15.8). There were significant differences between adult's and children's IQ and between verbal and nonverbal indexes. The level of education predicted both IQ and adaptive behavior. Testosterone replacement therapy and absence of seizures predicted only adaptive behavior. Conclusions The level of education and hormonal therapy can be selectively implicated in the intellectual variability in KS.
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Affiliation(s)
- Luciane Simonetti
- Universidade Federal de São Paulo, Departamento de Medicina, Divisão de Endocrinologia, São Paulo SP, Brazil
| | - Magnus Regios Dias da Silva
- Universidade Federal de São Paulo, Departamento de Medicina, Divisão de Endocrinologia, São Paulo SP, Brazil
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Incidence of gynaecomastia in Klinefelter syndrome adolescents and outcome of testosterone treatment. Eur J Pediatr 2021; 180:3201-3207. [PMID: 33934233 DOI: 10.1007/s00431-021-04083-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/23/2021] [Accepted: 04/15/2021] [Indexed: 12/21/2022]
Abstract
The aim was to define the true incidence of gynaecomastia in adolescent boys with Klinefelter syndrome (KS) and to observe testosterone treatment effects on its duration by examination of the prospectively collected data from a specialist referral clinic for boys with KS, with comparison being made with KS boys identified by a historical newborn chromosome screening programme, together with chromosomally normal controls. Fifty-nine boys over age 13 years were referred to a specialist KS clinic; 21 developed gynaecomastia. The comparator was 14 KS boys identified at birth and 94 chromosomally normal control boys. Testosterone was routinely started at the onset of puberty if gynaecomastia, a manifestation of clinical hypogonadism, was present. Oral or transdermal testosterone was administered in the morning, in a reverse physiological rhythm, and doses were increased according to standard pubertal regimens. The incidence of gynaecomastia was not increased in both the KS cohorts compared with controls. The incidence and age of onset of gynaecomastia was 35.6%, at 12.3 (1.8) years in the KS clinic group; 36.0%, at 13.7 (0.6) years in the newborn survey group; and 34.0%, at 13.6 (0.8) years in the controls. Full resolution of the gynaecomastia occurred in the 12/14 KS clinic boys on testosterone treatment who had completed puberty and as long as adherence was maintained.Conclusion: The incidence of gynaecomastia in KS boys (overall 35.6%) is not increased over typically developing boys. Commencing testosterone when gynaecomastia develops with physiological dose escalation and full adherence can result in the resolution of the gynaecomastia. What is Known: • Gynaecomastia is a common feature in Klinefelter syndrome men. • Hypogonadism occurs from mid-puberty onwards with the absence of the usual rise in testosterone levels. What is New: • The incidence of pubertal gynaecomastia in Klinefelter syndrome is not different from typically developing boys. • Early and prompt starting of testosterone gel treatment and increasing the dose physiologically may help to resolve the gynaecomastia without the need for surgery.
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Lafcı NG, Colak FK, Sahin G, Sakar M, Çetinkaya S, Savas-Erdeve S. Hypergonadotrophic hypogonadism in a patient with transaldolase deficiency: novel mutation in the pentose phosphate pathway. Hormones (Athens) 2021; 20:581-585. [PMID: 33159679 DOI: 10.1007/s42000-020-00252-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Transaldolase (TALDO) deficiency (OMIM #606003) is a rare autosomal recessive multi-systemic disorder of carbohydrate metabolism. It has a vast phenotypic spectrum ranging from neonatal liver failure to slowly progressive liver cirrhosis and is characterized by intrauterine growth restriction, hepatosplenomegaly, bicytopenia, nephrolithiasis, and congenital heart disease. METHODS AND RESULTS We report a patient with a late-onset form of TALDO deficiency characterized by hypergonadotropic hypogonadism and slightly elevated levels of alpha-fetoprotein (AFP). A novel TALDO1 mutation was detected through the application of reverse genetics with the use of clinical exome sequencing (CES). CONCLUSION This report provides further evidence that reverse genetics is a useful approach in patients who do not manifest the hallmark features of known and recognizable syndromes. TALDO deficiency should be considered in the differential diagnosis of unexplained elevated AFP levels and hypergonadotropic hypogonadism with microlithiasis.
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Affiliation(s)
- Naz Guleray Lafcı
- Dr. Sami Ulus Obstetrics and Gynecology, Children Health and Disease Training and Research Hospital, Department of Medical Genetics, Ankara, Turkey.
| | - Fatma Kurt Colak
- Dr. Sami Ulus Obstetrics and Gynecology, Children Health and Disease Training and Research Hospital, Department of Medical Genetics, Ankara, Turkey
| | - Gulseren Sahin
- Dr. Sami Ulus Obstetrics and Gynecology, Children Health and Disease Training and Research Hospital, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara, Turkey
| | - Merve Sakar
- Dr. Sami Ulus Obstetrics and Gynecology, Children Health and Disease Training and Research Hospital, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Semra Çetinkaya
- Dr. Sami Ulus Obstetrics and Gynecology, Children Health and Disease Training and Research Hospital, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Senay Savas-Erdeve
- Dr. Sami Ulus Obstetrics and Gynecology, Children Health and Disease Training and Research Hospital, Department of Pediatric Endocrinology, Ankara, Turkey
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8
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Kailash Y, Raheem AA, Homa ST. How Successful Is Surgical Sperm Retrieval in Klinefelter Syndrome? FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:636629. [DOI: 10.3389/frph.2021.636629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
Klinefelter Syndrome (KS) is characterized by the presence of an extra X chromosome. It was first diagnosed in 1942 in a group of azoospermic men. KS is the most common chromosomal abnormality encountered in infertile men and accounts for more than 10% of the causes of azoospermia. Men who are azoospermic may still father children via testicular sperm extraction followed by intracytoplasmic sperm injection (ICSI). This review article summarizes the success rates of the available techniques for surgical sperm retrieval (SSR) in KS including conventional testicular sperm extraction (cTESE) and micro testicular sperm extraction (mTESE), as well as the risks of these procedures for future fertility. The evidence indicates that the SSR rate is as successful in non-mosaic men with KS as those with normal karyotypes, with retrieval rates of up to 55% reported. The influence of different factors that affect the chances of a successful outcome are discussed. In particular, the impact of aneuploidy rate, physical characteristics, co-morbidities, reproductive endocrine balance and the use of different hormone management therapies are highlighted. Evidence is presented to suggest that the single most significant determinant for successful SSR is the age of the patient. The success of SSR is also influenced by surgical technique and operative time, as well as the skills of the surgeon and embryology team. Rescue mTESE may be used successfully following failed TESE in KS patients in combination with hormone stimulation.
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Gropman AL, Porter GF, Lasutschinkow PC, Sadeghin T, Tipton ES, Powell S, Samango-Sprouse CA. Neurocognitive development and capabilities in boys with 49,XXXXY syndrome. Am J Med Genet A 2020; 185:3541-3546. [PMID: 32662248 DOI: 10.1002/ajmg.a.61736] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/05/2020] [Indexed: 01/25/2023]
Abstract
49,XXXXY was previously associated with profound to severe intellectual deficits. However, prior research papers on the cognitive profiles of this population were confounded by small samples sizes, wide age spreads, and incomplete histories of testosterone replacement therapy. This study is the first comprehensive, international investigation of the neurocognitive aspects of 49,XXXXY, and the potential effects of biological treatment on this profile. Sixty-seven boys from infancy to 11 years of age were enrolled in this longitudinal study, with the majority of boys postnatally diagnosed though chromosomal analysis. These boys received a comprehensive neurocognitive evaluation tailored to specific language-based deficits and cognitive challenges. Results revealed higher neurocognitive capacities, both verbally and nonverbally, than previously reported in this disorder. Infant boys with 49,XXXXY who received early hormonal therapy (EHT) had significantly higher scores on the cognitive domain of the Bayley Scales of Infant Development than untreated infants (p = .013). In addition, treated school-aged participants had significantly better scaled scores than untreated boys in form completion (p = .042), a task that requires deductive reasoning, on nonverbal testing on the Leiter International Performance Scales. This study indicates greater cognitive capacities with a wide range of abilities in the child with 49,XXXXY, thus warranting further investigation to identify and understand the critical influences on the etiology and the variability of those capacities.
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Affiliation(s)
- Andrea L Gropman
- Division of Neurogenetics and Developments Pediatrics, Children's National Health System, Washington, District of Columbia, USA.,Department of Neurology, George Washington University, Washington, District of Columbia, USA
| | - Grace F Porter
- Research Department, The Focus Foundation, Davidsonville, Maryland, USA
| | | | - Teresa Sadeghin
- Research Department, The Focus Foundation, Davidsonville, Maryland, USA
| | | | - Sherida Powell
- Department of Economics, George Washington University, Washington, District of Columbia, USA
| | - Carole A Samango-Sprouse
- Research Department, The Focus Foundation, Davidsonville, Maryland, USA.,Department of Pediatrics, George Washington University, Washington, District of Columbia, USA.,Department of Human and Molecular Genetics, Florida International University, Miami, Florida, USA
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10
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A review of the intriguing interaction between testosterone and neurocognitive development in males with 47,XXY. Curr Opin Obstet Gynecol 2020; 32:140-146. [PMID: 32004174 DOI: 10.1097/gco.0000000000000612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Although 47,XXY (Klinefelter syndrome) was first discovered more than 50 years ago, there have been limited comprehensive studies on this disorder. The present review explains the study of neurodevelopmental dysfunction and the impact of testosterone replacement at specific junctions in the life of males with 47,XXY. The intricate relationship between testosterone, neurodevelopment, health, and well being warrants an in-depth investigation in order to achieve optimal outcomes. RECENT FINDINGS Current literature suggests that the implementation of biological treatment has a positive impact on numerous areas of neurodevelopment. Further research is needed to determine ideal dosage, timing, and frequency of biological treatment for efficacy and safety of the child with 47,XXY. SUMMARY As noninvasive prenatal screening has detected increasing numbers of fetuses with 47,XXY, parents may benefit from both prenatal and postnatal counseling, including the latest innovative biological treatment, that may further optimize the child's outcome, especially when coupled with targeted early intervention services.
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Tran SL, Samango‐Sprouse CA, Sadeghin T, Powell S, Gropman AL. Hormonal replacement therapy and its potential influence on working memory and competency/adaptive functioning in 47,XXY (Klinefelter syndrome). Am J Med Genet A 2019; 179:2374-2381. [DOI: 10.1002/ajmg.a.61360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/12/2019] [Accepted: 09/05/2019] [Indexed: 11/08/2022]
Affiliation(s)
| | - Carole A. Samango‐Sprouse
- The Focus Foundation Davidsonville Maryland
- Department of Human and Molecular Genetics Florida International University Miami Florida
- Department of Pediatrics George Washington University Washington District of Columbia
| | | | - Sherida Powell
- Department of Economics George Washington University Washington District of Columbia
| | - Andrea L. Gropman
- Department of Neurology George Washington University Washington District of Columbia
- Division of Neurogenetics and Developmental Pediatrics Children's National Health System Washington District of Columbia
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