1
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Grande G, Graziani A, Di Mambro A, Selice R, Ferlin A. Osteoporosis and bone metabolism in patients with Klinefelter syndrome. Endocr Connect 2023; 12:e230058. [PMID: 37166398 PMCID: PMC10388662 DOI: 10.1530/ec-23-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/11/2023] [Indexed: 05/12/2023]
Abstract
Low bone mass is common in men with Klinefelter syndrome (KS), with a prevalence of 6-15% of osteoporosis and of 25-48% of osteopenia. Reduced bone mass has been described since adolescence and it might be related to both reduced bone formation and higher bone resorption. Although reduced testosterone levels are clearly involved in the pathogenesis, this relation is not always evident. Importantly, fracture risk is increased independently from bone mineral density (BMD) and testosterone levels. Here we discuss the pathogenesis of osteoporosis in patients with KS, with a particular focus on the role of testosterone and testis function. In fact, other hormonal mechanisms, such as global Leydig cell dysfunction, causing reduced insulin-like factor 3 and 25-OH vitamin D levels, and high follicle-stimulating hormone and estradiol levels, might be involved. Furthermore, genetic aspects related to the supernumerary X chromosome might be involved, as well as androgen receptor expression and function. Notably, body composition, skeletal mass and strength, and age at diagnosis are other important aspects. Although dual-energy x-ray absorptiometry is recommended in the clinical workflow for patients with KS to measure BMD, recent evidence suggests that alterations in the microarchitecture of the bones and vertebral fractures might be present even in subjects with normal BMD. Therefore, analysis of trabecular bone score, high-resolution peripheral quantitative computed tomography and vertebral morphometry seem promising tools to better estimate the fracture risk of patients with KS. This review also summarizes the evidence on the best available treatments for osteoporosis in men with KS, with or without hypogonadism.
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Affiliation(s)
- Giuseppe Grande
- Unit of Andrology and Reproductive Medicine, University Hospital of Padova, Padova, Italy
| | | | - Antonella Di Mambro
- Unit of Andrology and Reproductive Medicine, University Hospital of Padova, Padova, Italy
| | - Riccardo Selice
- Unit of Andrology and Reproductive Medicine, University Hospital of Padova, Padova, Italy
| | - Alberto Ferlin
- Unit of Andrology and Reproductive Medicine, University Hospital of Padova, Padova, Italy
- Department of Medicine, University of Padova, Padova, Italy
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2
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López Krabbe HV, Holm Petersen J, Asserhøj LL, Johannsen TH, Christiansen P, Jensen RB, Cleemann LH, Hagen CP, Priskorn L, Jørgensen N, Main KM, Juul A, Aksglaede L. Reproductive hormones, bone mineral content, body composition, and testosterone therapy in boys and adolescents with Klinefelter syndrome. Endocr Connect 2023; 12:e230031. [PMID: 37010084 PMCID: PMC10305500 DOI: 10.1530/ec-23-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/04/2023]
Abstract
Adult patients with Klinefelter syndrome (KS) are characterized by a highly variable phenotype, including tall stature, obesity, and hypergonadotropic hypogonadism, as well as an increased risk of developing insulin resistance, metabolic syndrome, and osteoporosis. Most adults need testosterone replacement therapy (TRT), whereas the use of TRT during puberty has been debated. In this retrospective, observational study, reproductive hormones and whole-body dual-energy x-ray absorptiometry-derived body composition and bone mineral content were standardized to age-related standard deviation scores in 62 patients with KS aged 5.9-20.6 years. Serum concentrations of total testosterone and inhibin B were low, whereas luteinizing hormone and follicle-stimulating hormone were high in patients before TRT. Despite normal body mass index, body fat percentage and the ratio between android fat percentage and gynoid fat percentage were significantly higher in the entire group irrespective of treatment status. In patients evaluated before and during TRT, a tendency toward a more beneficial body composition with a significant reduction in the ratio between android fat percentage and gynoid fat percentage during TRT was found. Bone mineral content (BMC) did not differ from the reference, but BMC corrected for bone area was significantly lower when compared to the reference. This study confirms that patients with KS have an unfavorable body composition and an impaired bone mineral status already during childhood and adolescence. Systematic studies are needed to evaluate whether TRT during puberty will improve these parameters.
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Affiliation(s)
- Hans Valdemar López Krabbe
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jørgen Holm Petersen
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Louise Laub Asserhøj
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Fertility, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Trine Holm Johannsen
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Peter Christiansen
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Rikke Beck Jensen
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Line Hartvig Cleemann
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Casper P Hagen
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Lærke Priskorn
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Niels Jørgensen
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Katharina M Main
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lise Aksglaede
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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3
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Ross J, Bowden MR, Yu C, Diaz-Thomas A. Transition of young adults with metabolic bone diseases to adult care. Front Endocrinol (Lausanne) 2023; 14:1137976. [PMID: 37008909 PMCID: PMC10064010 DOI: 10.3389/fendo.2023.1137976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/06/2023] [Indexed: 03/19/2023] Open
Abstract
As more accurate diagnostic tools and targeted therapies become increasingly available for pediatric metabolic bone diseases, affected children have a better prognosis and significantly longer lifespan. With this potential for fulfilling lives as adults comes the need for dedicated transition and intentional care of these patients as adults. Much work has gone into improving the transitions of medically fragile children into adulthood, encompassing endocrinologic conditions like type 1 diabetes mellitus and congenital adrenal hyperplasia. However, there are gaps in the literature regarding similar guidance concerning metabolic bone conditions. This article intends to provide a brief review of research and guidelines for transitions of care more generally, followed by a more detailed treatment of bone disorders specifically. Considerations for such transitions include final adult height, fertility, fetal risk, heritability, and access to appropriately identified specialists. A nutrient-dense diet, optimal mobility, and adequate vitamin D stores are protective factors for these conditions. Primary bone disorders include hypophosphatasia, X-linked hypophosphatemic rickets, and osteogenesis imperfecta. Metabolic bone disease can also develop secondarily as a sequela of such diverse exposures as hypogonadism, a history of eating disorder, and cancer treatment. This article synthesizes research by experts of these specific disorders to describe what is known in this field of transition medicine for metabolic bone diseases as well as unanswered questions. The long-term objective is to develop and implement strategies for successful transitions for all patients affected by these various conditions.
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Affiliation(s)
- Jordan Ross
- Division of Pediatric Endocrinology, University of Tennessee Health Science Center, Memphis, TN, United States
- *Correspondence: Jordan Ross,
| | - Michelle R. Bowden
- Division of General Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
- Le Bonheur Children’s Hospital, Memphis, TN, United States
| | - Christine Yu
- Endocrinology Division, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Alicia Diaz-Thomas
- Division of Pediatric Endocrinology, University of Tennessee Health Science Center, Memphis, TN, United States
- Le Bonheur Children’s Hospital, Memphis, TN, United States
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4
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Ciobanu G, De Angelis F, Slabari E, Pompa G. Bone mineralization and immediate function of six dental implants in patients with Klinefelter syndrome. Clin Case Rep 2021; 9:e03142. [PMID: 34631058 PMCID: PMC8489383 DOI: 10.1002/ccr3.3142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 04/10/2019] [Accepted: 05/22/2019] [Indexed: 11/15/2022] Open
Abstract
Patients with Klinefelter syndrome face many challenges in oral treatment and bone mineralization due to multiple systemic dysfunctions. This case report follows the geometrical treatment with immediate implant loading of an adult male patient with Klinefelter syndrome. Satisfactory results were demonstrated in clinical follow-up.
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Affiliation(s)
- Galina Ciobanu
- Department of Stomatological and Maxillofacial Surgery oral implantology "Arsenie Gutan" Histology Unit University N. Testemitanu University of Medicine and Pharmacy of Moldova Chisinau Moldova
| | - Francesca De Angelis
- Prosthodontics Unit Department of Odontostomatological and Maxillofacial Sciences "Sapienza," University of Rome Rome Italy
| | - Eugen Slabari
- Department of Stomatological and Maxillofacial Surgery oral implantology "Arsenie Gutan" Histology Unit University N. Testemitanu University of Medicine and Pharmacy of Moldova Chisinau Moldova
| | - Giorgio Pompa
- Prosthodontics Unit Department of Odontostomatological and Maxillofacial Sciences "Sapienza," University of Rome Rome Italy
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5
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Kabilan A, Skakkebæk A, Chang S, Gravholt CH. Evaluation of the Efficacy of Transdermal and Injection Testosterone Therapy in Klinefelter Syndrome: A Real-Life Study. J Endocr Soc 2021; 5:bvab062. [PMID: 34056502 PMCID: PMC8143670 DOI: 10.1210/jendso/bvab062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Indexed: 12/15/2022] Open
Abstract
Context Klinefelter Syndrome (KS) is the most frequent sex chromosome disorder in males. Due to hypergonadotropic hypogonadism, treatment with testosterone replacement therapy (TRT) is commonly indicated. There are no international guidelines for the most appropriate TRT in KS. Objective We aimed to evaluate how different routes of testosterone administration impact testosterone-responsive variables, as well as the development of later metabolic diseases and other complications. Methods We conducted a retrospective study covering 5 years from 2015 to 2020. Data on TRT, biochemical parameters, bone mineral density (BMD), medications, comorbidity, and karyotyping were derived from electronic patient records and The Danish Cytogenetic Register. Results A total of 147 KS males were included: 81 received injection TRT, 61 received transdermal TRT, and 5 did not receive TRT. Testosterone levels were similar in the 2 TRT groups (P = 0.9), while luteinizing hormone and follicle-stimulating hormone levels were higher in the group receiving transdermal TRT (P = 0.002). Levels of cholesterol, blood glucose, hemoglobin A1c, hemoglobin, hematocrit, liver parameters, prostate-specific antigen, and spine and hip BMD were similar in the 2 treatment groups (Ps > 0.05). Conclusion TRT, irrespective of route of administration, affects androgen-responsive variables similarly in males with KS. Neither long-acting injection nor transdermal gel seem to reduce the risk of metabolic diseases significantly. These results should encourage clinicians in seeking the route of administration resulting in the highest degree of adhesion to treatment based on individual patient preferences. Implementation of shared decision-making with patients may be important when choosing TRT.
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Affiliation(s)
- Apiraa Kabilan
- Department of Endocrinology, Aarhus University Hospital, 8200 Aarhus, Denmark.,Department of Internal Medicine, Lillebaelt Hospital, 6000 Kolding, Denmark
| | - Anne Skakkebæk
- Department of Clinical Genetics, Aarhus University Hospital, 8200 Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Simon Chang
- Department of Endocrinology, Aarhus University Hospital, 8200 Aarhus, Denmark.,Department of Internal Medicine, Lillebaelt Hospital, 6000 Kolding, Denmark
| | - Claus H Gravholt
- Department of Endocrinology, Aarhus University Hospital, 8200 Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
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Shepherd S, Oates R. At what age should we attempt to retrieve sperm from males with Klinefelter syndrome. Transl Androl Urol 2021; 10:1432-1441. [PMID: 33850778 PMCID: PMC8039581 DOI: 10.21037/tau-19-858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Klinefelter syndrome (KS) is a common disorder and almost every clinician in almost every sub-specialty of medicine will knowingly or unwittingly treat boys or men with a 47,XXY chromosomal constitution. Although there are numerous aspects of KS worthy of discussion, this contribution will focus specifically on the controversial, and as yet unresolved, issue of whether it is advantageous to harvest testis tissue from peri-pubertal or adolescent boys with KS in a heroic effort to preserve that child’s chances of reproduction in his future adult life. What would be the rationale for that, how does the biology of spermatogenesis in the Klinefelter testis impact that decision, and what does the data show? The answer, assembled from a selection of seemingly disparate sources and directions, appears to be “No”. We do not have to advocate for an aggressive approach, we do not have to preemptively preserve future fertility. We can justifiably wait until adulthood with equivalent chances of success.
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Affiliation(s)
- Shanta Shepherd
- Department of Urology, Boston University School of Medicine, Boston, MA, USA
| | - Robert Oates
- Department of Urology, Boston University School of Medicine, Boston, MA, USA.,Department of Urology, Boston Medical Center, Boston, MA, USA
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7
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Vogiatzi MG, Davis SM, Ross JL. Cortical Bone Mass is Low in Boys with Klinefelter Syndrome and Improves with Oxandrolone. J Endocr Soc 2021; 5:bvab016. [PMID: 33733020 PMCID: PMC7947965 DOI: 10.1210/jendso/bvab016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Indexed: 12/17/2022] Open
Abstract
Context Klinefelter syndrome (KS) is the most common sex aneuploidy in men. Affected males have hypogonadism, and, as a result, face an increased risk for osteoporosis and fractures. Androgen therapy is standard in adolescents and adults with KS but has not been used earlier in childhood. Objective To determine the effects of androgen treatment on bone mass in children with KS. Methods Randomized, double-blind, placebo-controlled clinical trial of oxandrolone (OX; 0.06 mg/kg daily; n = 38) versus placebo (PL; n = 40) for 2 years in boys with KS (ages 4-12 years). Changes in bone mass were examined by digital x-ray radiogrammetry, which determines the Bone Health Index (BHI) and standard deviation score (SDS). Results BHI SDS was similar between groups at baseline (–0.46 ± 1.1 vs –0.34 ± 1.0 OX vs PL, P > .05) and higher in the OX group at 2 years (–0.1 ± 1.3 vs –0.53 ± 0.9, OX vs PL, P < .01). At baseline, BHI SDS values of all subjects were not normally distributed with 25.7% of subjects plotted below –1 SDS (P < .001), suggesting a deficit in bone mass. In total, 13.5% of subjects had sustained a fracture and their BHI SDS was lower than those with no fractures (–1.6 ± 1.3 vs –0.3 ± 1.0, P = .004). Conclusion Bone mass using BHI SDS is reduced in some children with KS and improves with OX. Since these individuals are at risk for osteoporosis, age-appropriate androgen replacement and future studies on bone health in children with KS should be further explored.
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Affiliation(s)
| | - Shanlee M Davis
- University of Colorado School of Medicine, Department of Pediatrics, Section of Endocrinology, Aurora, CO, USA
| | - Judith L Ross
- Thomas Jefferson University, Department of Pediatrics, Philadelphia, PA, United States.,A.I. DuPont Hospital for Children, Wilmington, DE, USA
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8
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Zitzmann M, Aksglaede L, Corona G, Isidori AM, Juul A, T'Sjoen G, Kliesch S, D'Hauwers K, Toppari J, Słowikowska-Hilczer J, Tüttelmann F, Ferlin A. European academy of andrology guidelines on Klinefelter Syndrome Endorsing Organization: European Society of Endocrinology. Andrology 2020; 9:145-167. [PMID: 32959490 DOI: 10.1111/andr.12909] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/13/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Knowledge about Klinefelter syndrome (KS) has increased substantially since its first description almost 80 years ago. A variety of treatment options concerning the spectrum of symptoms associated with KS exists, also regarding aspects beyond testicular dysfunction. Nevertheless, the diagnostic rate is still low in relation to prevalence and no international guidelines are available for KS. OBJECTIVE To create the first European Academy of Andrology (EAA) guidelines on KS. METHODS An expert group of academicians appointed by the EAA generated a consensus guideline according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. RESULTS Clinical features are highly variable among patients with KS, although common characteristics are severely attenuated spermatogenesis and Leydig cell impairment, resulting in azoospermia and hypergonadotropic hypogonadism. In addition, various manifestations of neurocognitive and psychosocial phenotypes have been described as well as an increased prevalence of adverse cardiovascular, metabolic and bone-related conditions which might explain the increased morbidity/mortality in KS. Moreover, compared to the general male population, a higher prevalence of dental, coagulation and autoimmune disorders is likely to exist in patients with KS. Both genetic and epigenetic effects due to the supernumerary X chromosome as well as testosterone deficiency contribute to this pathological pattern. The majority of patients with KS is diagnosed during adulthood, but symptoms can already become obvious during infancy, childhood or adolescence. The paediatric and juvenile patients with KS require specific attention regarding their development and fertility. CONCLUSION These guidelines provide recommendations and suggestions to care for patients with KS in various developmental stages ranging from childhood and adolescence to adulthood. This advice is based on recent research data and respective evaluations as well as validations performed by a group of experts.
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Affiliation(s)
- Michael Zitzmann
- Center for Reproductive Medicine and Andrology/Clinical and Surgical Andrology, University Hospital of Münster, Münster, Germany
| | - Lise Aksglaede
- Rigshospitalet, Department of Growth and Reproduction, University of Copenhagen, Copenhagen, Denmark
| | - Giovanni Corona
- Medical Department, Endocrinology Unit, Maggiore Bellaria Hospital, Azienda Usl, Bologna, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Advanced Endocrine Diagnostics Unit, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Anders Juul
- Rigshospitalet, Department of Growth and Reproduction, University of Copenhagen, Copenhagen, Denmark
| | - Guy T'Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Sabine Kliesch
- Center for Reproductive Medicine and Andrology/Clinical and Surgical Andrology, University Hospital of Münster, Münster, Germany
| | - Kathleen D'Hauwers
- Department of Urology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Jorma Toppari
- Department of Pediatrics, Institute of Biomedicine, Research Centre for Integrated Physiology and Pharmacology and Centre for Population Health Research, University Hospital, University of Turku, Turku, Finland
| | | | - Frank Tüttelmann
- Institute of Human Genetics, University of Münster, Münster, Germany
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
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9
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Vena W, Pizzocaro A, Indirli R, Amer M, Maffezzoni F, Delbarba A, Leonardi L, Balzarini L, Ulivieri FM, Ferlin A, Mantovani G, Lania AG, Ferrante E, Mazziotti G. Prevalence and determinants of radiological vertebral fractures in patients with Klinefelter syndrome. Andrology 2020; 8:1699-1704. [DOI: 10.1111/andr.12841] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Walter Vena
- Endocrinology, Diabetology and Andrology Unit Humanitas Clinical and Research CenterIRCCS Rozzano Italy
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
| | - Alessandro Pizzocaro
- Endocrinology, Diabetology and Andrology Unit Humanitas Clinical and Research CenterIRCCS Rozzano Italy
| | - Rita Indirli
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
- Endocrinology Unit Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico Milan Italy
| | - Myriam Amer
- Endocrinology, Diabetology and Andrology Unit Humanitas Clinical and Research CenterIRCCS Rozzano Italy
| | - Filippo Maffezzoni
- Endocrine and Metabolic Unit Department of Medicine ASST Spedali Civili Brescia Brescia Italy
| | - Andrea Delbarba
- Endocrine and Metabolic Unit Department of Medicine ASST Spedali Civili Brescia Brescia Italy
| | - Lorenzo Leonardi
- Department of Radiology Humanitas Clinical and Research CenterIRCCS Rozzano Italy
| | - Luca Balzarini
- Department of Radiology Humanitas Clinical and Research CenterIRCCS Rozzano Italy
| | - Fabio M. Ulivieri
- Nuclear Medicine Unit Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico Milan Italy
| | - Alberto Ferlin
- Endocrine and Metabolic Unit Department of Clinical and Experimental Sciences University of Brescia Brescia Italy
| | - Giovanna Mantovani
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
- Endocrinology Unit Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico Milan Italy
| | - Andrea G. Lania
- Endocrinology, Diabetology and Andrology Unit Humanitas Clinical and Research CenterIRCCS Rozzano Italy
- Department of Biomedical Sciences Humanitas University of Milan Milan Italy
| | - Emanuele Ferrante
- Endocrinology Unit Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico Milan Italy
| | - Gherardo Mazziotti
- Endocrinology, Diabetology and Andrology Unit Humanitas Clinical and Research CenterIRCCS Rozzano Italy
- Department of Biomedical Sciences Humanitas University of Milan Milan Italy
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10
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Tartaglia N, Howell S, Davis S, Kowal K, Tanda T, Brown M, Boada C, Alston A, Crawford L, Thompson T, van Rijn S, Wilson R, Janusz J, Ross J. Early neurodevelopmental and medical profile in children with sex chromosome trisomies: Background for the prospective eXtraordinarY babies study to identify early risk factors and targets for intervention. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:428-443. [PMID: 32506668 DOI: 10.1002/ajmg.c.31807] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 01/03/2023]
Abstract
Sex chromosome trisomies (SCT), including Klinefelter syndrome/XXY, Trisomy X, and XYY syndrome, occur in 1 of every 500 births. The past decades of research have resulted in a broadening of known associated medical comorbidities as well as advances in psychological research. This review summarizes what is known about early neurodevelopmental, behavioral, and medical manifestations in young children with SCT. We focus on recent research and unanswered questions related to the risk for neurodevelopmental disorders that commonly present in the first years of life and discuss the medical and endocrine manifestations of SCT at this young age. The increasing rate of prenatal SCT diagnoses provides the opportunity to address gaps in the existing literature in a new birth cohort, leading to development of the eXtraordinarY Babies Study. This study aims to better describe and compare the natural history of SCT conditions, identify predictors of positive and negative outcomes in SCT, evaluate developmental and autism screening measures commonly used in primary care practices for the SCT population, and build a rich data set linked to a bank of biological samples for future study. Results from this study and ongoing international research efforts will inform evidence-based care and improve health and neurodevelopmental outcomes.
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Affiliation(s)
- Nicole Tartaglia
- eXtraordinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA.,Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Susan Howell
- eXtraordinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA.,Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Shanlee Davis
- eXtraordinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA.,Pediatric Endocrinology, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Karen Kowal
- Department of Pediatric Endocrinology, Nemours-Dupont Hospital for Children, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tanea Tanda
- Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Mariah Brown
- Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA.,Pediatric Endocrinology, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Cristina Boada
- Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Amanda Alston
- Department of Pediatric Endocrinology, Nemours-Dupont Hospital for Children, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Leah Crawford
- Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Talia Thompson
- Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Sophie van Rijn
- Clinical Neurodevelopment Sciences, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Rebecca Wilson
- eXtraordinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA.,Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Jennifer Janusz
- eXtraordinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA.,Neurology and Neuropsychology, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Judith Ross
- Pediatric Endocrinology, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA.,Department of Pediatric Endocrinology, Nemours-Dupont Hospital for Children, Wilmington, Delaware, USA
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11
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Willems M, Gies I, Van Saen D. Germ cell loss in Klinefelter syndrome: When and why? AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:356-370. [PMID: 32412180 DOI: 10.1002/ajmg.c.31787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 12/25/2022]
Abstract
Klinefelter syndrome (KS) is a quite common disorder with an incidence of 1-2 in 1,000 new-born males. Most patients are diagnosed in the light of a clinical checkup when consulting a fertility clinic with an unfulfilled child wish. Infertility in KS patients is caused by a massive germ cell loss, leading to azoospermia in more than 90% of the adult patients. Most seminiferous tubules in the adult KS testis are degenerated or hyalinized and testicular fibrosis can be observed, starting from puberty. However, focal spermatogenesis can be found in the testis of some patients. This offers the opportunity to extract spermatozoa from the testis by testicular sperm extraction (TESE). Nevertheless, TESE is only successful in about half of the KS adults seeking to father children. The reason for the germ cell loss remains unclear. To date, it is still debated whether the testicular tissue changes and the germ cell loss seen in KS is directly caused by an altered X-linked gene expression, the altered somatic environment, or a deficiency in the germ cells. In this review, we provide an overview of the current knowledge about the germ cell loss in KS patients.
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Affiliation(s)
- Margo Willems
- Biology of the Testis (BITE) Laboratory, Department of Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Inge Gies
- Department of Pediatrics, Division of Pediatric Endocrinology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Dorien Van Saen
- Biology of the Testis (BITE) Laboratory, Department of Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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12
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Bittker SS. Elevated Levels of 1,25-Dihydroxyvitamin D in Plasma as a Missing Risk Factor for Celiac Disease. Clin Exp Gastroenterol 2020; 13:1-15. [PMID: 32021373 PMCID: PMC6956711 DOI: 10.2147/ceg.s222353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/13/2019] [Indexed: 02/06/2023] Open
Abstract
The prevalence of celiac disease (CD) has increased significantly in some developed countries in recent decades. Potential risk factors that have been considered in the literature do not appear to provide a convincing explanation for this increase. This has led some researchers to hypothesize that there is a "missing environmental factor" that increases the risk of CD. Based on evidence from the literature, the author proposes that elevation in plasma levels of 1,25-dihydroxyvitamin D [1,25(OH)2D] is a missing risk factor for CD, and relatedly that significant oral vitamin D exposure is a "missing environmental factor" for CD. First, elevated plasma levels of 1,25(OH)2D are common in CD, especially in the newly diagnosed. Second, nine distinct conditions that increase plasma levels of 1,25(OH)2D are either associated with CD or have indications of such an association in the literature. Third, a retrospective study shows that sustained oral vitamin D supplementation in infancy is associated with increased CD risk, and other studies on comorbid conditions support this association. Fourth, large doses of oral vitamin D upregulate many of the same cytokines, chemokines, and toll-like receptors that are upregulated in CD. Fifth, epidemiological evidence, such as the timing of the inception of a CD "epidemic" in Sweden, the increased prevalence of CD in Finland and the United States in recent decades, the unusually low prevalence of CD in Germany, and the differential in prevalence between Finnish Karelians and Russian Karelians, may all be explained by oral vitamin D exposure increasing CD risk. The same is true of some seemingly contradictory results in the literature on the effects of breastfeeding on CD risk. If future research validates this hypothesis, adjustments to oral vitamin D consumption among those who have genetic susceptibility may decrease the risk of CD in these individuals.
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Russo V, Chen R, Armamento-Villareal R. Hypogonadism, Type-2 Diabetes Mellitus, and Bone Health: A Narrative Review. Front Endocrinol (Lausanne) 2020; 11:607240. [PMID: 33537005 PMCID: PMC7848021 DOI: 10.3389/fendo.2020.607240] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/30/2020] [Indexed: 12/26/2022] Open
Abstract
One of the complications from chronic hyperglycemia and insulin resistance due to type 2 diabetes mellitus (T2DM) on the hypothalamic-pituitary-gonadal axis in men is the high prevalence of hypogonadotropic hypogonadism (HH). Both T2DM and hypogonadism are associated with impaired bone health and increased fracture risk but whether the combination results in even worse bone disease than either one alone is not well-studied. It is possible that having both conditions predisposes men to an even greater risk for fracture than either one alone. Given the common occurrence of HH or hypogonadism in general in T2DM, a significant number of men could be at risk. To date, there is very little information on the bone health men with both hypogonadism and T2DM. Insulin resistance, which is the primary defect in T2DM, is associated with low testosterone (T) levels in men and may play a role in the bidirectional relationship between these two conditions, which together may portend a worse outcome for bone. The present manuscript aims to review the available evidences on the effect of the combination of hypogonadism and T2DM on bone health and metabolic profile, highlights the possible metabolic role of the skeleton, and examines the pathways involved in the interplay between bone, insulin resistance, and gonadal steroids.
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Affiliation(s)
- Vittoria Russo
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Rui Chen
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Reina Armamento-Villareal
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- *Correspondence: Reina Armamento-Villareal,
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14
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Chen JF, Lin PW, Tsai YR, Yang YC, Kang HY. Androgens and Androgen Receptor Actions on Bone Health and Disease: From Androgen Deficiency to Androgen Therapy. Cells 2019; 8:cells8111318. [PMID: 31731497 PMCID: PMC6912771 DOI: 10.3390/cells8111318] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022] Open
Abstract
Androgens are not only essential for bone development but for the maintenance of bone mass. Therefore, conditions with androgen deficiency, such as male hypogonadism, androgen-insensitive syndromes, and prostate cancer with androgen deprivation therapy are strongly associated with bone loss and increased fracture risk. Here we summarize the skeletal effects of androgens—androgen receptors (AR) actions based on in vitro and in vivo studies from animals and humans, and discuss bone loss due to androgens/AR deficiency to clarify the molecular basis for the anabolic action of androgens and AR in bone homeostasis and unravel the functions of androgen/AR signaling in healthy and disease states. Moreover, we provide evidence for the skeletal benefits of androgen therapy and elucidate why androgens are more beneficial than male sexual hormones, highlighting their therapeutic potential as osteoanabolic steroids in improving bone fracture repair. Finally, the application of selective androgen receptor modulators may provide new approaches for the treatment of osteoporosis and fractures as well as building stronger bones in diseases dependent on androgens/AR status.
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Affiliation(s)
- Jia-Feng Chen
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung 833, Taiwan;
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (P.-W.L.); (Y.-R.T.); (Y.-C.Y.)
| | - Pei-Wen Lin
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (P.-W.L.); (Y.-R.T.); (Y.-C.Y.)
- Center for Menopause and Reproductive Medicine Research, Department of Obstetrics and Gynecology, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung 833, Taiwan
| | - Yi-Ru Tsai
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (P.-W.L.); (Y.-R.T.); (Y.-C.Y.)
- Center for Menopause and Reproductive Medicine Research, Department of Obstetrics and Gynecology, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung 833, Taiwan
- An-Ten Obstetrics and Gynecology Clinic, Kaohsiung 802, Taiwan
| | - Yi-Chien Yang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (P.-W.L.); (Y.-R.T.); (Y.-C.Y.)
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Hong-Yo Kang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (P.-W.L.); (Y.-R.T.); (Y.-C.Y.)
- Center for Menopause and Reproductive Medicine Research, Department of Obstetrics and Gynecology, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung 833, Taiwan
- Correspondence: ; Tel.: +886-7-731-7123 (ext. 8898)
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15
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Samango-Sprouse CA, Counts DR, Tran SL, Lasutschinkow PC, Porter GF, Gropman AL. Update On The Clinical Perspectives And Care Of The Child With 47,XXY (Klinefelter Syndrome). Appl Clin Genet 2019; 12:191-202. [PMID: 31695472 PMCID: PMC6815760 DOI: 10.2147/tacg.s180450] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 09/20/2019] [Indexed: 12/13/2022] Open
Abstract
47,XXY (Klinefelter syndrome [KS]) is the most common sex chromosomal aneuploidy (1:660), yet, despite this, only 25% of the males are ever diagnosed. Males with 47,XXY present with characteristic symptoms throughout their lifetime with typical physical and neurodevelopmental manifestations focused in growth, cognitive development, endocrine function, and reproduction. Studies have demonstrated that optimal outcomes are dependent on early detection combined with consistent and targeted neurodevelopmental treatment throughout the lifespan. During infancy and into the preschool years, individuals with 47,XXY commonly face deficits in growth and development in the areas of early hormonal, motor, speech, and behavioral development. As they transition into school, the primary neurodevelopmental concerns include language difficulty, executive dysfunction, behavior, and learning and reading deficits. Adults with 47,XXY often present with taller than average height, low levels of fertility, azoospermia, and elevated gonadotropin levels. These presentations may persist from early childhood through adulthood but can be mitigated by appropriate interventions. Early neurodevelopmental and hormonal treatment has been shown to have a minimizing effect on the physical and neurodevelopmental manifestations in individuals with 47,XXY. With innovative and current research studies, the features common to the neurodevelopmental profile of 47,XXY have been further expanded and defined. Further research is necessary to elucidate and understand the relationship between the brain, behavior, and the phenotypic profile of 47,XXY.
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Affiliation(s)
- Carole A Samango-Sprouse
- Department of Pediatrics, George Washington University, Washington, DC, USA
- Department of Human and Molecular Genetics, Florida International University, Miami, FL, USA
- The Focus Foundation, Davidsonville, MD, USA
| | - Debra R Counts
- Pediatric Endocrinology, Sinai Hospital, Baltimore, MD, USA
| | | | | | | | - Andrea L Gropman
- Department of Neurology, George Washington University, Washington, DC, USA
- Division of Neurogenetics and Developmental Pediatrics, Children’s National Medical Center, Washington, DC, USA
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Juel Mortensen L, Lorenzen M, Jørgensen N, Andersson AM, Nielsen JE, Petersen LI, Lanske B, Juul A, Hansen JB, Blomberg Jensen M. Possible link between FSH and RANKL release from adipocytes in men with impaired gonadal function including Klinefelter syndrome. Bone 2019; 123:103-114. [PMID: 30914274 DOI: 10.1016/j.bone.2019.03.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/19/2019] [Accepted: 03/18/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The FSH receptor (FSHR) has been found to be expressed in human bone cells and bone marrow-adipocytes, and highly-debated mouse studies have suggested extra-gonadal effects of gonadotropins on glucose, adipocyte and bone homeostasis. These putative effects could be direct or indirectly mediated by endocrine factors released from bone-cells or adipocytes. Here, we investigated whether gonadotropins are linked with glucose- and lipid-metabolism in hypergonadotropic men. METHODS Single centre, cross-sectional study of 307 men with idiopathic infertility and 28 men with Klinefelter syndrome (KS). OUTCOME associations between serum LH and FSH with soluble-RANKL (sRANKL), osteoprotegerin (OPG), osteocalcin, fasting glucose and insulin, sex steroids, and body composition. Expression of FSHR was studied in human-derived adipocyte-cell-models (hMADS, TERT-hWA) and FSH stimulation of RANKL expression and secretion in hMADS in vitro. RESULTS Serum FSH was not directly linked with glucose- and lipid-metabolism. However, FSH was inversely associated with sRANKL in both infertile men and KS men (p = .023 and p = .012). Infertile men with elevated FSH (>11 U/L) had significantly lower sRANKL (p = .015). sRANKL was positively associated with fat percentage, fasting insulin, and glucose (all p < .05). Men with prediabetes had higher sRANKL (p = .021), but lower testosterone (p < .0001) and Inhibin B (p = .005). The FSHR was expressed in the investigated human derived adipocytes, and 3-6 h treatment with FSH markedly increased RANKL release (p < .05). CONCLUSION KS and infertile men with prediabetes have low Inhibin B, and testosterone but elevated RANKL compared with non-prediabetic men despite comparable levels of serum gonadotropins. Serum FSH and sRANKL was inversely associated in both infertile and KS men, but the increased release of RANKL from FSH treated adipocytes suggest a direct effect of FSH on RANKL production in some tissues. Further studies are required to clarify whether FSH targets RANKL in the skeleton. ClinicalTrial_ID:NCT01304927.
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Affiliation(s)
- Li Juel Mortensen
- Group of skeletal, mineral and gonadal endocrinology, University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark; Division of Bone and Mineral Research, HSDM/HMS, Harvard Medical School, Boston, USA
| | - Mette Lorenzen
- Group of skeletal, mineral and gonadal endocrinology, University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
| | - Niels Jørgensen
- University Department of Growth and Reproduction and International Center for Research, Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Anna-Maria Andersson
- University Department of Growth and Reproduction and International Center for Research, Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - John E Nielsen
- University Department of Growth and Reproduction and International Center for Research, Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Louise I Petersen
- Department of Biology, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Beate Lanske
- Division of Bone and Mineral Research, HSDM/HMS, Harvard Medical School, Boston, USA
| | - Anders Juul
- University Department of Growth and Reproduction and International Center for Research, Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Jacob B Hansen
- Department of Biology, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Martin Blomberg Jensen
- Group of skeletal, mineral and gonadal endocrinology, University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark; Division of Bone and Mineral Research, HSDM/HMS, Harvard Medical School, Boston, USA.
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Abstract
PURPOSE OF REVIEW Klinefelter syndrome is the most common sex chromosome abnormality in men. Hypogonadism and testicular degeneration are almost universal. Truncal adiposity, metabolic syndrome and low bone mass occur frequently. This review summarizes the most recent advances in the pathogenesis and management of the endocrine abnormalities in Klinefelter syndrome. It is expected that optimal endocrine management will improve outcomes and quality of life in Klinefelter syndrome. RECENT FINDINGS In Klinefelter syndrome, testosterone replacement is routinely prescribed despite lack of evidence on the optimal dose and time for initiation of therapy. Cross-sectional studies have linked hypogonadism to the development of metabolic abnormalities and low bone mass. Testosterone therapy, however, is not consistently associated with improved metabolic and bone outcomes. Increased truncal adiposity and high rates of metabolic syndrome are present in prepubertal children. A randomized trial of oxandrolone in prepubertal boys showed improvement in visual-motor function, socialization and cardiometabolic health. Testicular sperm extraction (TESE) has success rates similar to other causes of nonobstructive azoospermia when performed between 16 and 35 years of age. SUMMARY Endocrine care in Klinefelter syndrome should start in childhood and include evaluation of metabolic risk factors and bone health. Further research to guide evidence-based endocrine care is very much needed.
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Affiliation(s)
- Adriana Herrera Lizarazo
- Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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18
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Akcan N, Poyrazoğlu Ş, Baş F, Bundak R, Darendeliler F. Klinefelter Syndrome in Childhood: Variability in Clinical and Molecular Findings. J Clin Res Pediatr Endocrinol 2018; 10:100-107. [PMID: 29022558 PMCID: PMC5985377 DOI: 10.4274/jcrpe.5121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Klinefelter syndrome (KS) is the most common (1/500–1/1000) chromosomal disorder in males, but only 10% of cases are identified in childhood. This study aimed to review the data of children with KS to assess the age and presenting symptoms for diagnosis, clinical and laboratory findings, together with the presence of comorbidities. METHODS Twenty-three KS patients were analyzed retrospectively. Age at admission, presenting symptoms, comorbid problems, height, weight, pubertal status, biochemical findings, hormone profiles, bone mineral density and karyotype were evaluated. Molecular analysis was also conducted in patients with ambiguous genitalia. RESULTS The median age of patients at presentation was 3.0 (0.04-16.3) years. Most of the cases were diagnosed prenatally (n=15, 65.2%). Other reasons for admission were scrotal hypospadias (n=3, 14.3%), undescended testis (n=2, 9.5%), short stature (n=1, 4.8%), isolated micropenis (n=1, 4.8%) and a speech disorder (n=1, 4.8%). The most frequent clinical findings were neurocognitive disorders, speech impairment, social and behavioral problems and undescended testes. All except two patients were prepubertal at admission. Most of the patients (n=20, 86.9%) showed the classic 47,XXY karyotype. Steroid 5 alpha-reductase 2 gene and androgen receptor gene mutations were detected in two of the three cases with genital ambiguity. CONCLUSION Given the large number of underdiagnosed KS patients before adolescence, pediatricians need to be aware of the phenotypic variability of KS in childhood. Genetic analysis in KS patients may reveal mutations associated with other forms of disorders of sex development besides KS.
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Affiliation(s)
- Neşe Akcan
- Near East University Faculty of Medicine, Department of Pediatric Endocrinology, Nicosia, Cyprus,* Address for Correspondence: Near East University Faculty of Medicine, Department of Pediatric Endocrinology, Nicosia, Cyprus Phone: +90 392 675 10 00 E-mail:
| | - Şükran Poyrazoğlu
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Firdevs Baş
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Rüveyde Bundak
- University of Kyrenia Faculty of Medicine, Department of Pediatric Endocrinology, Kyrenia, Cyprus
| | - Feyza Darendeliler
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
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Tangseefa P, Martin SK, Fitter S, Baldock PA, Proud CG, Zannettino ACW. Osteocalcin-dependent regulation of glucose metabolism and fertility: Skeletal implications for the development of insulin resistance. J Cell Physiol 2017; 233:3769-3783. [PMID: 28834550 DOI: 10.1002/jcp.26163] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/22/2017] [Indexed: 01/22/2023]
Abstract
The skeleton has recently emerged as a critical insulin target tissue that regulates whole body glucose metabolism and male reproductive function. While our understanding of these new regulatory axes remains in its infancy, the bone-specific protein, osteocalcin, has been shown to be centrally involved. Undercarboxylated osteocalcin acts as a secretagogue in a feed-forward loop to stimulate pancreatic β-cell proliferation and insulin secretion, improve insulin sensitivity, and promote testosterone production. Importantly, dysregulation of insulin signaling in bone causes a reduction in serum osteocalcin levels that is associated with elevated blood glucose and reduced serum insulin levels, suggesting that the skeleton may play a significant role in the development of diet-induced insulin resistance. Insulin signaling is negatively regulated by the mammalian target of rapamycin complex 1 (mTORC1) which becomes hyper-activated in response to nutrient overload. Loss- and gain-of function models suggest that mTORC1 function in bone is essential for normal skeletal development; however, the role of this complex in the regulation of glucose metabolism remains to be determined. This review highlights our current understanding of the role played by osteocalcin in the skeletal regulation of glucose metabolism and fertility. In particular, it examines data emerging from transgenic mouse models which have revealed a pancreas-bone-testis regulatory axis and discusses recent human studies which seek to corroborate findings from mouse models with clinical observations. Moreover, we review recent studies which suggest dysregulation of insulin signaling in bone leads to the development of insulin resistance and discuss the potential role of mTORC1 signaling in this process.
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Affiliation(s)
- Pawanrat Tangseefa
- Faculty of Health and Medical Science, Myeloma Research Laboratory, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Sally K Martin
- Faculty of Health and Medical Science, Myeloma Research Laboratory, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Stephen Fitter
- Faculty of Health and Medical Science, Myeloma Research Laboratory, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Paul A Baldock
- Skeletal Metabolism Group, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Christopher G Proud
- Nutrition & Metabolism, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Biological Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Department of Biochemistry and Genetics, School of Medicine, Zhejiang University, Hangzhou, China
| | - Andrew C W Zannettino
- Faculty of Health and Medical Science, Myeloma Research Laboratory, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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20
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Stagi S, Di Tommaso M, Scalini P, Sandini E, Masoni F, Chiarelli F, Verrotti A, Giglio S, Romano S, de Martino M. Cross-sectional study shows that impaired bone mineral status and metabolism are found in nonmosaic triple X syndrome. Acta Paediatr 2017; 106:619-626. [PMID: 28090675 DOI: 10.1111/apa.13744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/11/2016] [Accepted: 01/10/2017] [Indexed: 12/11/2022]
Abstract
AIM The effect of a supernumerary X chromosome on bones has not been reported, and this study evaluated bone mineral status and metabolism in nonmosaic triple X syndrome. METHODS This cross-sectional study comprised 19 girls, with a median age of 10.9 years, with nonmosaic triple X syndrome and a control group matched for age and body size. We studied ionised and total calcium, phosphate, parathyroid hormone (PTH), 25-hydroxyvitamin D (25(OH)D), 1,25-dihydroxyvitamin D, osteocalcin, bone alkaline phosphatase levels and urinary deoxypyridinoline concentrations. We also measured the phalangeal amplitude-dependent speed of sound (AD-SoS) and the bone transmission time (BTT) Z-scores. RESULTS Patients with nonmosaic triple X syndrome showed significantly reduced AD-SoS (p < 0.005) and BTT Z-scores (p < 0.0001) compared to the control group, and these results persisted when we divided the sample into prepubertal and pubertal patients (p < 0.05). These patients also had significantly reduced ionised calcium (p < 0.005) and 25(OH)D levels (p < 0.005) and higher phosphate (p < 0.0001) and PTH (p < 0.0001) levels. CONCLUSION Subjects with nonmosaic triple X syndrome exhibited a significant impairment in bone mineral status and metabolism similar to other X polisomy, such as Klinefelter's syndrome. This suggests the presence of a primary bone deficit and the need for regular and close monitoring of these subjects.
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Affiliation(s)
- Stefano Stagi
- Department of Health Sciences; University of Florence, Anna Meyer Children's University Hospital; Florence Italy
| | | | - Perla Scalini
- Department of Health Sciences; University of Florence, Anna Meyer Children's University Hospital; Florence Italy
| | - Elena Sandini
- Department of Health Sciences; University of Florence, Anna Meyer Children's University Hospital; Florence Italy
| | | | | | - Alberto Verrotti
- Department of Paediatrics; University of L'Aquila; L'Aquila Italy
| | - Sabrina Giglio
- Genetics and Molecular Medicine Unit; Anna Meyer Children's University Hospital; Florence Italy
| | - Silvia Romano
- Genetics and Molecular Medicine Unit; Anna Meyer Children's University Hospital; Florence Italy
| | - Maurizio de Martino
- Department of Health Sciences; University of Florence, Anna Meyer Children's University Hospital; Florence Italy
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