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Cueto-Robledo G, Jurado-Hernandez MY, Camacho-Delgado FR, Roldan-Valadez E, Heredia-Arroyo AL, Cueto-Romero HD, Palafox LEG, Anaya RO, Dircio AR, Vazquez HM, Mateo PA. Pulmonary Thromboendarterectomy in Klinefelter Syndrome. Literature Review. Curr Probl Cardiol 2021; 47:101003. [PMID: 34571108 DOI: 10.1016/j.cpcardiol.2021.101003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/14/2021] [Indexed: 02/08/2023]
Abstract
Klinefelter syndrome is a form of male hypogonadism due to testicular sclerohyalinosis with atrophy and azoospermia, which is the most common cause of male infertility. The syndrome is usually accompanied by metabolic, morphological, and neurobehavioral manifestations; Venous thromboembolic diseases such as deep vein thrombosis and pulmonary embolism. The existence of chronic thromboembolic pulmonary hypertension in patients with Klinefelter syndrome is scarce in the literature. We present the imaging and genetic analysis of a 37 -year-old male with a history of deep vein thrombosis who was admitted for exertional dyspnea.
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Affiliation(s)
- Guillermo Cueto-Robledo
- Cardiorespiratory emergencies, Hospital General de México "Dr Eduardo Liceaga", Mexico City, Mexico; Pulmonary circulation clinic, Hospital General de México "Dr Eduardo Liceaga", Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | | | - Ernesto Roldan-Valadez
- Directorate of Research, Hospital General de Mexico "Dr Eduardo Liceaga", Mexico City, Mexico; I.M. Sechenov First Moscow State Medical Universit (Sechenov University), Department of Radiology, Moscow, Russia
| | | | | | | | - Roberto Ocampo Anaya
- Interventional Radiology service, Hospital General de Mexico "Dr Eduardo Liceaga", Mexico city, Mexico
| | - Adriana Reyes Dircio
- Interventional Radiology service, Hospital General de Mexico "Dr Eduardo Liceaga", Mexico city, Mexico
| | - Hugo Monroy Vazquez
- Interventional Radiology service, Hospital General de Mexico "Dr Eduardo Liceaga", Mexico city, Mexico
| | - Porres-Aguilar Mateo
- Department of Medicine; Division of Hospital Medicine and Adult Thrombosis Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
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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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Glueck CJ, Wang P. Testosterone therapy, thrombosis, thrombophilia, cardiovascular events. Metabolism 2014; 63:989-94. [PMID: 24930993 DOI: 10.1016/j.metabol.2014.05.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/06/2014] [Accepted: 05/11/2014] [Indexed: 12/13/2022]
Abstract
There are similar time intervals between starting testosterone therapy (TT) and development of thrombotic (~4.5 months) or cardiovascular (CVD) events (~3 months) which may, speculatively, reflect a shared pathophysiology. We have described thrombotic events 5 months (median) after starting TT in 38 men and 4 women, including 27 with deep venous thrombosis-pulmonary embolism, 12 with osteonecrosis, 1 with central retinal vein thrombosis, 1 with amaurosis fugax, and 1 with spinal cord infarction. In 8 men whose TT was continued, second thrombotic events occurred despite adequate anticoagulation with Coumadin in 8 men, 3 of whom had a third thrombotic event. Of these 42 cases, 40 had measures of thrombophilia-hypofibrinolysis, and 39 were found to have previously undiagnosed thrombophilia-hypofibrinolysis. Before beginning TT, especially in men with previous history of thrombotic events, we suggest that, at a minimum, measurements be made for the Factor V Leiden and Prothrombin mutations, Factors VIII and XI, and homocysteine, to identify men who should not receive TT. We need prospective data focused on whether there should be pre-TT screening based on history of previous venous thromboembolism or for all subjects for major gene thrombophilias. To better resolve questions about TT and all cause and cardiovascular morbidity and mortality and thrombosis, a long term, prospective, randomized, blinded study following the example of the Women's Health Initiative is needed. While we wait for prospective placebo-controlled TT outcome data, TT should be restricted to men with well-defined androgen deficiency syndromes.
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Affiliation(s)
- Charles J Glueck
- Jewish Hospital Cholesterol, Metabolism, Thrombosis Center, Jewish Hospital of Cincinnati, Cincinnati, OH, USA.
| | - Ping Wang
- Jewish Hospital Cholesterol, Metabolism, Thrombosis Center, Jewish Hospital of Cincinnati, Cincinnati, OH, USA
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Successful pulmonary endarterectomy in a patient with klinefelter syndrome. Case Rep Pulmonol 2013; 2012:104195. [PMID: 23304604 PMCID: PMC3530858 DOI: 10.1155/2012/104195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 11/26/2012] [Indexed: 11/18/2022] Open
Abstract
Klinefelter syndrome (KS) is a frequent genetic disorder due to one or more supernumerary X chromosomes. KS is associated with an increased risk for venous thromboembolic events like deep venous thrombosis and pulmonary embolism. This paper describes a 37-year-old male patient with KS referred to our tertiary center with chronic thromboembolic pulmonary hypertension, and who was successfully treated by pulmonary endarterectomy.
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Chung JW, Lee JB, Kim BH, Hong SP, Son JY, Lee YS, Kim JH, Seong MJ. Recurrent deep vein thrombosis and pulmonary embolism in a patient with Klinefelter's syndrome. Herz 2012; 38:306-8. [PMID: 23052903 DOI: 10.1007/s00059-012-3690-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 08/10/2012] [Accepted: 08/23/2012] [Indexed: 10/27/2022]
Abstract
Klinefelter's syndrome, which is characterized by small testes, gynecomastia, hypogonadism, and infertility, is the most common cause of primary testicular failure, and commonly has an XXY karyotype. Deep vein thrombosis and thomboembolic events are a rare occurrence in these patients. Although the exact mechanism is not completely understood, it is thought that increased thromboembolic risk in hypogonadic men can be explained by hypofibrinolysis resulting from androgen deficiency. We present the case of a 48-year-old man with Klinefelter's syndrome who experienced recurrent episodes of deep venous thrombosis and pulmonary embolism while undergoing therapeutic anticoagulation. Our report discusses this association and management of the prothrombotic state in patients with Klinefelter's syndrome.
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Affiliation(s)
- J-W Chung
- Department of Internal Medicine, College of Medicine, Dongguk University, Seoul, Kyungju, Korea
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Recurrent deep vein thrombosis and pulmonary embolism in a young man with Klinefelterʼs syndrome and heterozygous mutation of MTHFR-677C>T and 1298A>C. Blood Coagul Fibrinolysis 2010; 21:372-5. [DOI: 10.1097/mbc.0b013e32833894eb] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ayli M, Ertek S. Serious venous thromboembolism, heterozygous factor V Leiden and prothrombin G20210A mutations in a patient with Klinefelter syndrome and type 2 diabetes. Intern Med 2009; 48:1681-5. [PMID: 19755774 DOI: 10.2169/internalmedicine.48.1985] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Klinefelter's syndrome (KS) is a common cause of man infertility characterized by small testes, gynecomastia and hypogonadism. Deep vein thrombosis and thomboembolic events are frequent in these patients. Hormone imbalance and co-existent mutations in the coagulation system may be the primary factors in this hypercoagulable state. The increased thromboembolic risk in hypogonadic men has been explained by hypofibrinolysis due to androgen deficiency. Regarding the association between KS and congenital and acquired thrombophilias, to date, only three cases have been. Here, we present the youngest KS case with pulmonary thromboembolism with the heterozygous mutations in factor V Leiden and prothrombin genes, as detected by further tests. He had the previous diagnosis of diabetes mellitus and body mass index was 30 kg/m(2). Our report discusses the prothrombotic state in KS patients, with other possible causes for the young presentation and the importance of necessary tests in emergency service admissions with embolism.
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Affiliation(s)
- Meltem Ayli
- Department of Hematology, Ufuk University Faculty of Medicine, Ankara, Turkey
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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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Lapecorella M, Marino R, De Pergola G, Scaraggi FA, Speciale V, De Mitrio V. Severe venous thromboembolism in a young man with Klinefelter's syndrome and heterozygosis for both G20210A prothrombin and factor V Leiden mutations. Blood Coagul Fibrinolysis 2003; 14:95-8. [PMID: 12544736 DOI: 10.1097/00001721-200301000-00017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Klinefelter's syndrome is the most common cause of primary testicular failure, resulting in impairment of both spermatogenesis and testosterone production. It is a chromosomal disorder characterized by small, firm testes, azoospermia, gynecomastia, varying degrees of eunuchoidism and testosterone deficiency with elevated gonadotropin plasma levels. In Klinefelter's syndrome there is an increase of certain systemic diseases including venous thromboembolism. An increased thromboembolic risk in hypogonadic men has been explained with hypofibrinolysis due to androgen deficiency. Only two cases have been reported about the association between Klinefelter's syndrome and well-known congenital or acquired thrombophilias. We report the case of a 39-year-old patient with Klinefelter's syndrome who underwent severe deep venous thrombosis with pulmonary embolism, in the absence of any circumstantial triggering event. Further examinations also showed a double heterozygosis for G20210A prothrombin and factor V Leiden mutations. This case suggests that the increased thromboembolic risk, reported in Klinefelter's syndrome, can be worsened by the co-existence of one or more well-known thrombophilic conditions, as shown by the relatively young age of the patient. More studies are needed to clearly understand the pathogenesis of venous thromboembolism in males affected by Klinefelter's syndrome.
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Affiliation(s)
- Mario Lapecorella
- Centro Emostasi e Trombosi, Dipartimento di Clinica Medica, Immunologia e Malattie Infettive (MIDIM), University of Bari School of Medicine, Italy
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Boos CJ, Matfin G. Klinefelter's syndrome manifesting as an acute pulmonary embolus in a 52-year-old man. Endocr Pract 2002; 8:68-9. [PMID: 11939765 DOI: 10.4158/ep.8.1.68] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Chris J Boos
- Department of General Medicine and Endocrinology, Royal Hospital Haslar, Gosport, United Kingdom
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