Klinefelter Syndrome
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Transcript Klinefelter Syndrome
Tall Stature with
Arrested Puberty
M. Hashemipour
Professor of Pediatric Endocrinology
Isfahan University of Medical Sciences
Case 1
15.5 year-old boy
•
Referred for gynaecomastia.
•
Tall stature, does not want to grow taller.
What do you ask him?
Case 1
o
o
o
o
Tall since early childhood, but more excessively at 12
years
Pubic hair started at age 12
sense of smell
School performance
Forgetful, Poor academic performance
Family history
The only child.
Mother: one miscarriage, healthy, height 145 cm
Father: type 2 diabetes, height 163 cm
What's important in Physical examination?
145
163
What's important in Physical examination?
Auxology
Height 179.1 cm;
Arm span 186cm
Weight 87.0 kg
BMI 27.2
voice did not change
Gynaecomastia noted at the age of 12 years old
Pubertal exam
Pubertal Staging
Pubertal exam
Testes 4/4 mls
Pubic hair TS 4
Eunuchoid body
habitus
Gynaecomastia
Abdominal striae
BP 12/7
what's Eunuchoid body habitués
Arm span _ Height
The arm span is the distance between the tips of
the middle fingers when the arms are raised to a
horizontal position .
Arm span - Height
1 – 7 yr
8 – 12 yr
> 12 yr : Boys
Girls
17
_3
0
+1
+4
Upper to lower segment
The upper segment to lower segment ratio
Birth
: 1.7
3 years: 1.33
5 years : 1.17
10 years : 1.0
Upper to lower segment
pre-puberty
During
ratio
puberty
Adult men
Adult woman
≥1
≤1
o.92
0.95
Eunuchoid proportions
Lower segment 2-5cm >upper segment
Arm span – Height> + 5 cm
What's your investigation
Bone age
Bone age: 14 years at
chronological age 15
years 6 months
Investigations
LH: 35.6 mIU/ml (prepubertal <1.0)
FSH 51.8 mIU/ml (prepubertal <1.0)
Testosterone 4.5 nmol/L (pubertal 8.4-28.7)
FBS, lipid profile and liver enzymes: normal
Chromosomal Study
Chromosomal study
47 XXY
Father: 46 XY
Mother: 46 XX
what is the most likely diagnosis?
Diagnosis
Klinefelter
syndrome with
Gynaecomastia
Obesity
Treatment
Testosterone 100mg 4-weekly, and to achieve
250mg 4-weekly by 6 months.
Obesity:
Weight reduction: healthy diet, behavioural changes,
exercise
Gynaecomastia
Monitor for regression after starting testosterone
and weight reduction
May need surgery if fails to regress
Discussions
Klinefelter Syndrome (1942)
Prevalence 1 in 500-1000 males
Increased incidence with advanced maternal age
Classical KS: 47 XXY (80-90%)
Variants:
46 XY/47 XXY mosaicism
48 XXXY; 48 XXYY
Phenotypic males with 46 XX, Y to X translocation
Klinefelter Syndrome
Mutation causes:
Hyalinization and fibrosis of seminiferous tubules
and aggregation of Leydig cells
Azoospermia
Variable testosterone deficiency
Elevated gonadotropin
Klinefelter Syndrome
Clinical features: diagnosis rarely made before puberty
Height: above average, disproportionately long legs
Small penile size
Low IQ
learning disabilities
Features of Klinefelter’s
syndrome
Taller than average
height
Reduced libido
Reduced facial and body
hair
Gynaecomastia
Small testes
Fatigue
Depression
Osteoporosis
Fat accumulation
(abdomen, hips)
Poor erections
Infertility
Handelsman DJ, Zajac JD. Med J Aust 2004; 180: 529–35.
Klinefelter Syndrome
At risk of:
Low bone mineral density
Type 2 DM
Varicose veins, venous thrombosis, pulmonary
embolism
Early tooth decay
Klinefelter Syndrome
At risk of
Infertility
Breast carcinoma
Extra-gonadal germ cell mediastinal
Increased incidence of autoimmune disease: SLE,
RA and Sjogren synd.
Klinefelter Syndrome
Treatment:
Androgen replacement
Surgery for severe gynaecomastia.