1
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Hamie L, Eid E, Khalil J, Touma Sawaya R, Abbas O, Kurban M. Genodermatoses with behavioural sequelae. Postgrad Med J 2021; 98:799-810. [PMID: 37062993 DOI: 10.1136/postgradmedj-2020-139539] [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: 12/06/2020] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 11/04/2022]
Abstract
Children with genodermatoses are at an increased risk of developing behavioural disorders which may impart lasting damage on the individual and their family members. As such, early recognition of childhood mental health disorders via meticulous history taking, thorough physical examination, and disorder-specific testing is of paramount importance for timely and effective intervention. If carried out properly, prompt psychiatric screening and intervention can effectively mitigate, prevent or even reverse, the psychiatric sequela in question. To that end, this review aims to inform the concerned physician of the manifestations and treatment strategies relevant to the psychological sequelae of genodermatoses.
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Affiliation(s)
- Lamiaa Hamie
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Edward Eid
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joanna Khalil
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Ossama Abbas
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen Kurban
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon .,Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon.,Division of Genomics and Translational Biomedicine, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
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2
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Tharakan T, Salonia A, Corona G, Dhillo W, Minhas S, Jayasena C. The Role of Hormone Stimulation in Men With Nonobstructive Azoospermia Undergoing Surgical Sperm Retrieval. J Clin Endocrinol Metab 2020; 105:5893978. [PMID: 32810280 DOI: 10.1210/clinem/dgaa556] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023]
Abstract
Nonobstructive azoospermia, (NOA) is the most common cause of azoospermia. NOA is characterized by hypergonadotropic hypogonadism, testicular failure, and impaired spermatogenesis. The recent development of surgical sperm retrieval techniques such as microsurgical testicular sperm extraction (mTESE) has, for the first time, allowed some men with NOA to father biological children. It is common practice for endocrine stimulation therapies such as gonadotropins, selective estrogen receptor modulators (SERMs), and aromatase inhibitors to be used prior to mTESE to increase intratesticular testosterone synthesis with the aim of improving sperm retrieval rates; however, there is currently a paucity of data underpinning their safety and efficacy. We present 2 cases of men with NOA undergoing endocrine stimulation therapy and mTESE. We also discuss the current evidence and controversies associated with the use of hormonal stimulation therapy in couples affected by this severe form of male infertility.
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Affiliation(s)
- Tharu Tharakan
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Andrea Salonia
- Division of Experimental Oncology/Unite of Urology, URI, IRCCS Ospedale, San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Giovanni Corona
- Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | - Waljit Dhillo
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Suks Minhas
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Channa Jayasena
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
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3
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Ouazzani GE, Toutai C, Alla I, Ismaili N, Ouafi NE. Acute pulmonary embolism as an initial presentation of Klinefelter syndrome. J Saudi Heart Assoc 2020; 32:114-117. [PMID: 33154903 PMCID: PMC7640606 DOI: 10.37616/2212-5043.1020] [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: 10/27/2019] [Revised: 12/07/2019] [Accepted: 12/10/2019] [Indexed: 11/20/2022] Open
Abstract
Venous thromboembolism (VTE) includes deep vein thrombosis and its complications and pulmonary embolism. Cancer, surgery, prolonged immobilization, fractures, paralysis, use of oral contraceptives, and hereditary coagulopathies are classic risk factors for VTE. An increased incidence of VTE has been reported in patients with Klinefelter syndrome (KS), with a reported prevalence of 0.1–0.2% in the general population and up to 3.1% in infertile men. Despite the high rate of thromboembolic disease in patients with KS, the etiology of this phenomenon is not well understood, and most of our current knowledge is limited to small sample studies. We present the case of a 56-year-old man admitted for the management of a pulmonary embolism in whom a KS was accidentally discovered.
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Affiliation(s)
- Ghizlane El Ouazzani
- Department of Cardiology, Mohammed VI University Hospital, University Mohammed First of Oujda, 60049 Oujda, Morocco
| | - Chaimae Toutai
- Department of Cardiology, Mohammed VI University Hospital, University Mohammed First of Oujda, 60049 Oujda, Morocco
| | - Ikbal Alla
- Department of Cardiology, Mohammed VI University Hospital, University Mohammed First of Oujda, 60049 Oujda, Morocco
| | - Nabila Ismaili
- Department of Cardiology, Mohammed VI University Hospital, University Mohammed First of Oujda, 60049 Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital, University Mohammed First of Oujda, 60049 Oujda, Morocco
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4
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Saito K, Iwata Y, Kobayashi T, Sugiura K. Refractory skin ulcers associated with Klinefelter syndrome. J Dermatol 2020; 47:e207-e209. [PMID: 32124473 DOI: 10.1111/1346-8138.15287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kenta Saito
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yohei Iwata
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tsukane Kobayashi
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kazumitsu Sugiura
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
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5
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Arizanovic L, Spasic S, Miljevic C, Spasic MB, Nikolic M. A Case Report of Exacerbation of Leg Ulcers Associated with Acute High-dose Acetylsalicylic Acid in a Patient with Klinefelter Syndrome. Cureus 2019; 11:e6449. [PMID: 31893193 PMCID: PMC6929241 DOI: 10.7759/cureus.6449] [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] [Indexed: 11/05/2022] Open
Abstract
Klinefelter syndrome (KS) is the most frequent type of congenital sex-chromosomal disorder caused by at least one extra X chromosome and commonly treated with lifetime testosterone therapy. Ulcerative lesions on lower extremities may occur as a complication of KS. The pathogenesis of ulcers in KS patients has not been clarified on a molecular level. Here we present a case of leg ulcers exacerbation associated with the administration of a high dose of acetylsalicylic acid in a 63-year-old KS patient with karyotype 47,XXY undergoing testosterone replacement therapy for the last 20 years. The appearance of the ulcer on the patient's leg occurred during one week of high oral acetylsalicylic acid intake (1.2 g daily). The patient was advised to return to his standard daily dose of 0.1 g of acetylsalicylic acid and significant improvement of his leg ulcer was observed after two weeks. We hypothesize that testosterone-mediated nitric oxide balance in KS patient is perturbed under the condition of acute high-dose acetylsalicylic acid administration. We propose that small standard doses of approximately 0.1 g/day of acetylsalicylic acid have no apparent effect on nitric oxide status, whereas higher doses may cause dysregulation of nitric oxide production and/or utilization, creating conditions which may cause the appearance of leg ulcers in the KS patients.
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Affiliation(s)
- Lena Arizanovic
- Biochemistry, University of Belgrade - Faculty of Chemistry, Belgrade, SRB
| | - Snezana Spasic
- Chemistry, Institute of Chemistry, Technology and Metallurgy, University of Belgrade, Belgrade, SRB
| | - Cedo Miljevic
- Psychiatry, Institute of Mental Health, University of Belgrade - Faculty of Medicine, Belgrade, SRB
| | - Mihajlo B Spasic
- Physiology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, Belgrade, SRB
| | - Milan Nikolic
- Biochemistry, University of Belgrade - Faculty of Chemistry, Belgrade, SRB
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6
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Accardo G, Amoresano Paglionico V, Di Fraia R, Cittadini A, Salzano A, Esposito D, De Bellis A, Pasquali D. Management of cardiovascular complications in Klinefelter syndrome patients. Expert Rev Endocrinol Metab 2019; 14:145-152. [PMID: 30793993 DOI: 10.1080/17446651.2019.1584036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Klinefelter syndrome (KS), also known as 47, XXY, shows increased mortality when compared with mortality rates among the general population. Cardiovascular, hemostatic, metabolic diseases are implicated. Moreover, cardiac congenital anomalies in KS can contribute to the increase in mortality. AREAS COVERED In this study, we have systematically reviewed the relationships between KS and the cardiovascular system and the management of cardiovascular complication. In summary, patients with KS display increased cardiovascular risk profile, characterized by increased prevalence of metabolic alterations including dyslipidemia, diabetes mellitus (DM), and abnormalities in biomarkers of cardiovascular disease. KS subjects are characterized by subclinical abnormalities in endothelial function and in left ventricular (LV) systolic and diastolic function, which - when associated with chronotropic incompetence - may negatively influence cardiopulmonary performance. Moreover, KS patients appear to be at a higher risk for cardiovascular disease, due to thromboembolic events with high prevalence of recurrent venous ulcers, venous insufficiency, recurrent venous and arterial thromboembolism leading to deep venous thrombosis or pulmonary embolism. EXPERT OPINION Considering the unequivocal finding of increased mortality of KS patients, we suggest a periodic cardiovascular follow up in specialized centers with multidisciplinary care teams that comprise endocrinologists and cardiologists dedicated to KS syndrome.
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Affiliation(s)
- Giacomo Accardo
- a Department of Medical, Surgical, Neurologic , Metabolic and Aging Sciences, University of Campania "L. Vanvitelli" Naples , Naples , Italy
| | - Vanda Amoresano Paglionico
- a Department of Medical, Surgical, Neurologic , Metabolic and Aging Sciences, University of Campania "L. Vanvitelli" Naples , Naples , Italy
| | - Rosa Di Fraia
- a Department of Medical, Surgical, Neurologic , Metabolic and Aging Sciences, University of Campania "L. Vanvitelli" Naples , Naples , Italy
| | - Antonio Cittadini
- b Department of Translational Medical Sciences , Federico II University School of Medicine , Naples , Italy
| | - Andrea Salzano
- b Department of Translational Medical Sciences , Federico II University School of Medicine , Naples , Italy
| | - Daniela Esposito
- a Department of Medical, Surgical, Neurologic , Metabolic and Aging Sciences, University of Campania "L. Vanvitelli" Naples , Naples , Italy
- c Department of Endocrinology Institute of Medicine , Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Annamaria De Bellis
- a Department of Medical, Surgical, Neurologic , Metabolic and Aging Sciences, University of Campania "L. Vanvitelli" Naples , Naples , Italy
| | - Daniela Pasquali
- a Department of Medical, Surgical, Neurologic , Metabolic and Aging Sciences, University of Campania "L. Vanvitelli" Naples , Naples , Italy
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Pappalardo F, Cozzani E, Gallino A, Mainetti C. Chronic refractory leg ulcers in mosaic Klinefelter's syndrome: the importance of a prompt diagnosis and appropriate treatment. Ital J Dermatol Venerol 2018; 156:93-95. [PMID: 30251809 DOI: 10.23736/s2784-8671.18.06155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Fabrizio Pappalardo
- Department of Dermatology, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Emanuele Cozzani
- Di.S.Sal, Section of Dermatology, San Martino Policlinic Hospital, University of Genoa, Genoa, Italy -
| | - Augusto Gallino
- Department of Internal Medicine, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Carlo Mainetti
- Department of Dermatology, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
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8
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Calogero AE, Giagulli VA, Mongioì LM, Triggiani V, Radicioni AF, Jannini EA, Pasquali D. Klinefelter syndrome: cardiovascular abnormalities and metabolic disorders. J Endocrinol Invest 2017; 40:705-712. [PMID: 28258556 DOI: 10.1007/s40618-017-0619-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/15/2017] [Indexed: 10/20/2022]
Abstract
Klinefelter syndrome (KS) is one of the most common genetic causes of male infertility. This condition is associated with much comorbidity and with a lower life expectancy. The aim of this review is to explore more in depth cardiovascular and metabolic disorders associated to KS. KS patients have an increased risk of cerebrovascular disease (standardized mortality ratio, SMR, 2.2; 95% confidence interval, CI, 1.6-3.0), but it is not clear whether the cause of the death is of thrombotic or hemorrhagic nature. Cardiovascular congenital anomalies (SMR, 7.3; 95% CI, 2.4-17.1) and the development of thrombosis or leg ulcers (SMR, 7.9; 95% CI, 2.9-17.2) are also more frequent in these subjects. Moreover, cardiovascular abnormalities may be at least partially reversed by testosterone replacement therapy (TRT). KS patients have also an increased probability of endocrine and/or metabolic disease, especially obesity, metabolic syndrome and type 2 diabetes mellitus. The effects of TRT on these abnormalities are not entirely clear.
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Affiliation(s)
- A E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", via S. Sofia 78, 95123, Catania, Italy.
| | - V A Giagulli
- Department of Endocrinology and Metabolic Diseases, University of Bari, Bari, Italy
| | - L M Mongioì
- Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", via S. Sofia 78, 95123, Catania, Italy
| | - V Triggiani
- Outpatient Clinic for Endocrinology and Metabolic Diseases, Conversano Hospital, Conversano, Italy
| | - A F Radicioni
- Department of Experimental Medicine, La Sapienza University of Rome, Rome, Italy
| | - E A Jannini
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - D Pasquali
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy
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Glueck CJ, Jetty V, Goldenberg N, Shah P, Wang P. Thrombophilia in Klinefelter Syndrome With Deep Venous Thrombosis, Pulmonary Embolism, and Mesenteric Artery Thrombosis on Testosterone Therapy: A Pilot Study. Clin Appl Thromb Hemost 2016; 23:973-979. [PMID: 27582022 DOI: 10.1177/1076029616665923] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We compared thrombophilia and hypofibrinolysis in 6 men with Klinefelter syndrome (KS), without previously known familial thrombophilia, who had sustained deep venous thrombosis (DVT)-pulmonary emboli (PE) or mesenteric artery thrombosis on testosterone replacement therapy (TRT). After the diagnosis of KS, TRT had been started in the 6 men at ages 11, 12, 13, 13, 19, and 48 years. After starting TRT, DVT-PE or mesenteric artery thrombosis was developed in 6 months, 1, 11, 11, 12, and 49 years. Of the 6 men, 4 had high (>150%) factor VIII (177%, 192%, 263%, and 293%), 3 had high (>150%) factor XI (165%, 181%, and 193%), 1 was heterozygous for the factor V Leiden mutation, and 1 was heterozygous for the G20210A prothrombin gene mutation. None of the 6 men had a precipitating event before their DVT-PE. We speculate that the previously known increased rate of DVT-PE and other thrombi in KS reflects an interaction between prothrombotic, long-term TRT with previously undiagnosed familial thrombophilia. Thrombophilia screening in men with KS before starting TRT would identify a cohort at increased risk for subsequent DVT-PE, providing an optimally informed estimate of the risk/benefit ratio of TRT.
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Affiliation(s)
- Charles J Glueck
- 1 The Jewish Hospital of Cincinnati, Dept. of Internal Medicine, Cincinnati, Ohio, USA.,2 The Cholesterol, Metabolism, and Thrombosis Center, Cincinnati, OH, USA
| | - Vybhav Jetty
- 1 The Jewish Hospital of Cincinnati, Dept. of Internal Medicine, Cincinnati, Ohio, USA.,2 The Cholesterol, Metabolism, and Thrombosis Center, Cincinnati, OH, USA
| | - Naila Goldenberg
- 1 The Jewish Hospital of Cincinnati, Dept. of Internal Medicine, Cincinnati, Ohio, USA.,2 The Cholesterol, Metabolism, and Thrombosis Center, Cincinnati, OH, USA
| | - Parth Shah
- 1 The Jewish Hospital of Cincinnati, Dept. of Internal Medicine, Cincinnati, Ohio, USA.,2 The Cholesterol, Metabolism, and Thrombosis Center, Cincinnati, OH, USA
| | - Ping Wang
- 2 The Cholesterol, Metabolism, and Thrombosis Center, Cincinnati, OH, USA
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Di Minno MND, Esposito D, Di Minno A, Accardo G, Lupoli G, Cittadini A, Giugliano D, Pasquali D. Increased platelet reactivity in Klinefelter men: something new to consider. Andrology 2015. [DOI: 10.1111/andr.12080] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M. N. D. Di Minno
- Department of Clinical Medicine and Surgery; University Federico II; Naples Italy
- Unit of Cell and Molecular Biology in Cardiovascular Diseases; Centro Cardiologico Monzino; IRCCS; Milan Italy
| | - D. Esposito
- Department of Cardiothoracic and Respiratory Sciences; Endocrine Unit; Second University of Naples; Naples Italy
| | - A. Di Minno
- Unit of Cell and Molecular Biology in Cardiovascular Diseases; Centro Cardiologico Monzino; IRCCS; Milan Italy
| | - G. Accardo
- Department of Cardiothoracic and Respiratory Sciences; Endocrine Unit; Second University of Naples; Naples Italy
| | - G. Lupoli
- Department of Clinical Medicine and Surgery; University Federico II; Naples Italy
| | - A. Cittadini
- Department of Medical Traslational Sciences; University Federico II; Naples Italy
| | - D. Giugliano
- Department of Medical, Surgical, Neurological, Metabolic Sciences and Geriatrics; Second University of Naples; Naples Italy
| | - D. Pasquali
- Department of Cardiothoracic and Respiratory Sciences; Endocrine Unit; Second University of Naples; Naples Italy
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11
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Giltay JC, Maiburg MC. Klinefelter syndrome: clinical and molecular aspects. Expert Rev Mol Diagn 2014; 10:765-76. [DOI: 10.1586/erm.10.63] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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12
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Villemur B, Wion-Barbot N, Blaise S, Payraud E, Turchet K, Seetha V, Miron A, De Angelis MP. Quel est l’intérêt de rechercher un hypogonadisme chez un patient présentant des ulcères de jambe récidivant depuis l’âge de 20ans ? ACTA ACUST UNITED AC 2012; 37:155-8. [DOI: 10.1016/j.jmv.2012.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 03/09/2012] [Indexed: 10/28/2022]
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Matsunaga Y, Goto A, Wakasugi H, Itoh A, Yonezawa K, Itoh M, Fujii K, Suzuki K, Abe T, Ushijima K, Shinomura Y. Extensive portal and mesenteric vein thrombosis in a young man with Klinefelter's syndrome. Hepatol Res 2012; 42:103-9. [PMID: 22175800 DOI: 10.1111/j.1872-034x.2011.00903.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Klinefelter's syndrome (KS) is a unique physical condition characterized by tall stature, eunuchoid body proportions, gynecomastia, and azoospermia, in addition to an extra X chromosome. In contrast to the original description, symptoms or physical findings can be extremely varied. KS is the most common chromosomal disorder, with an incidence of 1 in 500 males and is also the most commonly undiagnosed chromosomal disorder. Here, we present the case of a 26-year-old man with KS, who visited our hospital with complaints of abdominal pain and fever. On a routine physical examination, he did not differ from a normal karyotype male. Computed tomography showed extensive portal and mesenteric vein thrombosis (PMVT). It is well known that KS is frequently associated with venous thrombosis, but KS with PMVT has rarely been reported. Approximately one-third of PMVT is idiopathic, but this case suggests the possibility that undiagnosed KS is one of the causes of PMVT, as some individuals with KS are not easily distinguishable from those with the normal karyotype.
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Affiliation(s)
- Yasutaka Matsunaga
- Department of Gastroenterology, Kushiro City General Hospital, Kushiro First Department of Internal Medicine, Sapporo Medical University, Sapporo, Japan
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14
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Thukuntla S, Kumar P. Improvement of venous leg ulcers with androgen replacement therapy in a patient with undiagnosed klinefelter syndrome. DERMATO-ENDOCRINOLOGY 2011; 3:233-4. [PMID: 22259649 DOI: 10.4161/derm.3.4.15333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 02/28/2011] [Indexed: 11/19/2022]
Abstract
Klinefelter syndrome (KS) is the most common genetic form of male hypogonadism. The majority (80-90%) of patients have 47, XXY karyotype while mosaicism is seen in only 10-20% of patients. Leg ulcers may be a presenting symptom of KS with a prevalence of 6-13%. Treatment with testosterone has been reported to improve the ulcers.
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Affiliation(s)
- Shwetha Thukuntla
- Division of Endocrinology; Department of Internal Medicine; University of Texas; Southwestern Residency Programs at Seton Family of Hospitals; Austin, TX USA
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15
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Frühmesser A, Kotzot D. Chromosomal variants in klinefelter syndrome. Sex Dev 2011; 5:109-23. [PMID: 21540567 DOI: 10.1159/000327324] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2011] [Indexed: 12/13/2022] Open
Abstract
Klinefelter syndrome (KS) describes the phenotype of the most common sex chromosome abnormality in humans and occurs in one of every 600 newborn males. The typical symptoms are a tall stature, narrow shoulders, broad hips, sparse body hair, gynecomastia, small testes, absent spermatogenesis, normal to moderately reduced Leydig cell function, increased secretion of follicle-stimulating hormone, androgen deficiency, and normal to slightly decreased verbal intelligence. Apart from that, amongst others, osteoporosis, varicose veins, thromboembolic disease, or diabetes mellitus are observed. Some of the typical features can be very weakly pronounced so that the affected men often receive the diagnosis only at the adulthood by their infertility. With a frequency of 4%, KS is described to be the most common genetic reason for male infertility. The most widespread karyotype in affected patients is 47,XXY. Apart from that, various other karyotypes have been described, including 46,XX in males, 47,XXY in females, 47,XX,der(Y), 47,X,der(X),Y, or other numeric sex chromosome abnormalities (48,XXXY, 48,XXYY, and 49,XXXXY). The focus of this review was to abstract the different phenotypes, which come about by the various karyotypes and to compare them to those with a 'normal' KS karyotype. For that the patients have been divided into 6 different groups: Klinefelter patients with an additional isochromosome Xq, with additional rearrangements on 1 of the 2 X chromosomes or accordingly on the Y chromosome, as well as XX males and true hermaphrodites, 47,XXY females and Klinefelter patients with other numeric sex chromosome abnormalities. In the latter, an almost linear increase in height and developmental delay was observed. Men with an additional isochromosome Xq show infertility and other minor features of 'normal' KS but not an increased height. Aside from the infertility, in male patients with other der(X) as well as der(Y) rearrangements and in XXY women no specific phenotype is recognizable amongst others due to the small number of cases. The phenotype of XX males depends on the presence of SRY (sex-determining region Y) and the level of X inactivation at which SRY-negative patients are generally rarely observed.
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Affiliation(s)
- A Frühmesser
- Division for Human Genetics, Department for Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Austria
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16
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[35-year old patient with severe thromboembolism]. Internist (Berl) 2010; 51:1567-70. [PMID: 21069275 DOI: 10.1007/s00108-010-2652-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We report a case of a 35 year old male with severe deep vein thrombosis of the lower limb on both sides and pulmonary embolism. A Klinefelter's mosaic (47,XXY [81%]/48,XXXY [19%]) was diagnosed. Because no other cause for this thromboembolism was found, we assume that in part, it was caused by the Klinefelter's mosaic. In all male patients presenting with thromboembolism, especially those with an unusual habitus, a Klinefelter's syndrome should be considered as differential diagnosis. Testosterone substitution therapy should be started in all patients with Klinefelter's syndrome to prevent further disease.
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18
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Ozbek M, Oztürk MA, Ureten K, Ceneli O, Erdogan M, Haznedaroglu IC. Severe arterial thrombophilia associated with a homozygous MTHFR gene mutation (A1298C) in a young man with Klinefelter syndrome. Clin Appl Thromb Hemost 2007; 14:369-71. [PMID: 18160591 DOI: 10.1177/1076029607304750] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Klinefelter syndrome (KS) is the most common sex chromosome disorder in men. It may be associated with an increased risk for venous thrombosis and thromboembolism, which is partially explained by hypofibrinolysis due to androgen deficiency. Additional genetic or acquired thrombophilic states have been shown in KS patients complicated with venous thrombosis as isolated case reports. Arterial thrombotic events had not been previously reported in KS. In this study, a young man with KS who developed acute arterial thrombosis during testosterone replacement therapy is presented. He was homozygous for the A1298C mutation of the methylenetetrahydrofolate reductase (MTHFR) gene.
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Affiliation(s)
- Mustafa Ozbek
- Department of Endocrinology, Saglik Bakanligi Etlik Ihtisas Hastanesi
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19
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Margery J, Le Berre JP, Bredin C, Bordier L, Dupuy O, Mayaudon H, Guigay J, Bauducea B. Diagnostic d’un syndrome de Klinefelter trois ans après chirurgie d’exérèse d’un tératome médiastinal. Presse Med 2005; 34:1078-9. [PMID: 16334884 DOI: 10.1016/s0755-4982(05)84120-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The association between some types of tumor and Klinefelter's syndrome (KS) is often missed and diagnosis of the latter delayed, as in this case report. CASE We present the case of a 20 year-old patient for whom KS was not diagnosed until three years after thoracic surgery for a mediastinal teratoma. DISCUSSION The association between KS and mediastinal germ-cell tumors is not coincidental; it illustrates the relation between aneuploidy and oncogenesis. In a young adult male, palpation of the scrotum to look for microorchidism is justified when these tumors are diagnosed because 25% occur in patients with KS.
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Affiliation(s)
- J Margery
- Service de pneumologie, HIA Percy, Clamart (92).
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20
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Dissemond J, Knab J, Lehnen M, Goos M. Increased activity of factor VIII coagulant associated with venous ulcer in a patient with Klinefelter's syndrome. J Eur Acad Dermatol Venereol 2005; 19:240-2. [PMID: 15752302 DOI: 10.1111/j.1468-3083.2004.01117.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Klinefelter's syndrome is the most frequent major abnormality of sexual differentiation in men with two or more X chromosomes. Recurrent venous ulcers as a result of a post-thrombotic syndrome are a well known symptom in patients with Klinefelter's syndrome. Until now the underlying pathomechanisms are not completely understood. Platelet hyperaggregability, factor V Leiden mutation and abnormalities in fibrinolysis were implicated as possible contributing factors. Here we describe the detection of an increased activity of factor VIII coagulant (factor VIII:C). This is the first case report on increased factor VIII:C activity associated with venous ulcers in a patient with Klinefelter's syndrome. Elevated factor VIII plasma levels are gradually accepted to be associated with an increased risk for venous thromboembolism. Therefore, we discuss that the examination of factor VIII:C may help in clarifying individual thromboembolic risks, especially in patients with Klinefelter's syndrome.
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Affiliation(s)
- J Dissemond
- Department of Dermatology, University of Essen, D-45122 Essen, Germany.
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21
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Lewis VJ, Finlay AY. Two Decades Experience of the Psoriasis Disability Index. Dermatology 2005; 210:261-8. [PMID: 15942210 DOI: 10.1159/000084748] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2004] [Accepted: 10/15/2004] [Indexed: 11/19/2022] Open
Abstract
The Psoriasis Disability Index (PDI) was formed 20 years ago. Since its introduction it has been used widely as a tool for assessment of quality of life in psoriasis. This paper reviews its use in 23 peer-reviewed articles and over 35 published abstracts, and describes its use in conjunction with other general and psoriasis-specific quality of life assessments, and with a range of physical and psychological measures. The PDI is effective in demonstrating the effects of interventions, both of treatments and in health service research. The PDI has been translated into at least 16 languages and has been used in published research in 20 countries.
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Affiliation(s)
- Victoria J Lewis
- Department of Dermatology, Wales College of Medicine, Cardiff University, Cardiff, UK
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22
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Abstract
Klinefelter's syndrome is the most common genetic cause of human male infertility, but many cases remain undiagnosed because of substantial variation in clinical presentation and insufficient professional awareness of the syndrome itself. Early recognition and hormonal treatment of the disorder can substantially improve quality of life and prevent serious consequences. Testosterone replacement corrects symptoms of androgen deficiency but has no positive effect on infertility. However, nowadays patients with Klinefelter's syndrome, including the non-mosaic type, need no longer be considered irrevocably infertile, because intracytoplasmic sperm injection offers an opportunity for procreation even when there are no spermatozoa in the ejaculate. In a substantial number of azoospermic patients, spermatozoa can be extracted from testicular biopsy samples, and pregnancies and livebirths have been achieved. The frequency of sex chromosomal hyperploidy and autosomal aneuploidies is higher in spermatozoa from patients with Klinefelter's syndrome than in those from normal men. Thus, chromosomal errors might in some cases be transmitted to the offspring of men with this syndrome. The genetic implications of the fertilisation procedures, including pretransfer or prenatal genetic assessment, must be explained to patients and their partners.
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Affiliation(s)
- Fabio Lanfranco
- Institute of Reproductive Medicine of the University of Münster, Domagkstrasse 11, D-48129 Münster, Germany
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