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Phenotype of the Adulthood

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Klinefelter’s Syndrome

Abstract

Clinical presentation of Klinefelter’s syndrome is highly heterogeneous, explaining why the disease is often undiagnosed. Klinefelter patients have traditionally been described as tall, with gynecomastia, small and firm testicles. Beyond this classical phenotype, less distinct phenotypes have been described with less evident features. The reduction of the volume of the testes remains the peculiar clinical hallmark of Klinefelter’s syndrome. The broad spectrum of Klinefelter phenotypes depends on the genetic background (mosaicism, number of supernumerary X chromosome) as well as the degree of hypogonadism, patient’s age, and delay in the diagnosis. The relationship between clinical phenotype and pathogenesis is still not completely understood and needs to be fully elucidated, in order to facilitate the diagnosis and the clinical management of this condition. As expected, the degree of severity of the phenotype influences psychosocial issues and quality of life in these patients.

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References

  1. Klinefelter HF Jr, Reifenstein EC Jr, Albright F Jr, et al. J Clin Endocrinol. 1942;2(11):615–27.

    Article  CAS  Google Scholar 

  2. Jacobs PA, Strong JA. A case of human intersexuality having a possible XXY sex-determining mechanism. Nature. 1959;183(4657):302–3.

    Article  CAS  PubMed  Google Scholar 

  3. Visootsak J, Graham JM Jr. Klinefelter syndrome and other sex chromosomal aneuploidies. Orphanet J Rare Dis. 2006;1:42.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bonomi M, Rochira V, Pasquali D, Balercia G, Jannini EA, Ferlin A. Klinefelter syndrome (KS): genetics, clinical phenotype and hypogonadism. J Endocrinol Invest. 2017;40(2):123–34.

    Article  CAS  PubMed  Google Scholar 

  5. Lanfranco F, Kamischke A, Zitzmann M, Nieschlag E. Klinefelter’s syndrome. Lancet. 2004;364(9430):273–83.

    Article  CAS  PubMed  Google Scholar 

  6. Bojesen A, Gravholt CH. Klinefelter syndrome in clinical practice. Nat Clin Pract Urol. 2007;4(4):192–204.

    Article  PubMed  Google Scholar 

  7. Simpson JL, de la Cruz F, Swerdloff RS, Samango-Sprouse C, Skakkebaek NE, Graham JM Jr, et al. Klinefelter syndrome: expanding the phenotype and identifying new research directions. Genet Med. 2003;5(6):460–8.

    Article  PubMed  Google Scholar 

  8. Zitzmann M, Depenbusch M, Gromoll J, Nieschlag E. X-chromosome inactivation patterns and androgen receptor functionality influence phenotype and social characteristics as well as pharmacogenetics of testosterone therapy in Klinefelter patients. J Clin Endocrinol Metab. 2004;89(12):6208–17.

    Article  CAS  PubMed  Google Scholar 

  9. Groth KA, Skakkebaek A, Host C, Gravholt CH, Bojesen A. Clinical review: Klinefelter syndrome—a clinical update. J Clin Endocrinol Metab. 2013;98(1):20–30.

    Article  CAS  PubMed  Google Scholar 

  10. Bojesen A, Juul S, Gravholt CH. Prenatal and postnatal prevalence of Klinefelter syndrome: a national registry study. J Clin Endocrinol Metab. 2003;88(2):622–6.

    Article  CAS  PubMed  Google Scholar 

  11. Gravholt CH, Chang S, Wallentin M, Fedder J, Moore P, Skakkebaek A. Klinefelter syndrome: integrating genetics, neuropsychology, and endocrinology. Endocr Rev. 2018;39(4):389–423.

    Article  PubMed  Google Scholar 

  12. Bojesen A, Kristensen K, Birkebaek NH, Fedder J, Mosekilde L, Bennett P, et al. The metabolic syndrome is frequent in Klinefelter’s syndrome and is associated with abdominal obesity and hypogonadism. Diabetes Care. 2006;29(7):1591–8.

    Article  PubMed  Google Scholar 

  13. Salzano A, D'Assante R, Heaney LM, Monaco F, Rengo G, Valente P, et al. Klinefelter syndrome, insulin resistance, metabolic syndrome, and diabetes: review of literature and clinical perspectives. Endocrine. 2018;61(2):194–203.

    Article  CAS  PubMed  Google Scholar 

  14. Bojesen A, Hertz JM, Gravholt CH. Genotype and phenotype in Klinefelter syndrome—impact of androgen receptor polymorphism and skewed X inactivation. Int J Androl. 2011;34(6 Pt 2):e642–8.

    Article  CAS  PubMed  Google Scholar 

  15. Samplaski MK, Lo KC, Grober ED, Millar A, Dimitromanolakis A, Jarvi KA. Phenotypic differences in mosaic Klinefelter patients as compared with non-mosaic Klinefelter patients. Fertil Steril. 2014;101(4):950–5.

    Article  PubMed  Google Scholar 

  16. Sharma A, Jamil MA, Nuesgen N, Schreiner F, Priebe L, Hoffmann P, et al. DNA methylation signature in peripheral blood reveals distinct characteristics of human X chromosome numerical aberrations. Clin Epigenetics. 2015;7:76.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Viana J, Pidsley R, Troakes C, Spiers H, Wong CC, Al-Sarraj S, et al. Epigenomic and transcriptomic signatures of a Klinefelter syndrome (47,XXY) karyotype in the brain. Epigenetics. 2014;9(4):587–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Zitzmann M, Nieschlag E. The CAG repeat polymorphism within the androgen receptor gene and maleness. Int J Androl. 2003;26(2):76–83.

    Article  CAS  PubMed  Google Scholar 

  19. Eriksson AL, Perry JRB, Coviello AD, Delgado GE, Ferrucci L, Hoffman AR, et al. Genetic determinants of circulating estrogen levels and evidence of a causal effect of estradiol on bone density in men. J Clin Endocrinol Metab. 2018;103(3):991–1004.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Belli S, Santi D, Leoni E, Dall'Olio E, Fanelli F, Mezzullo M, et al. Human chorionic gonadotropin stimulation gives evidence of differences in testicular steroidogenesis in Klinefelter syndrome, as assessed by liquid chromatography-tandem mass spectrometry. Eur J Endocrinol. 2016;174(6):801–11.

    Article  CAS  PubMed  Google Scholar 

  21. Santi D, De Vincentis S, Scaltriti S, Rochira V. Relative hyperestrogenism in Klinefelter syndrome: results from a meta-analysis. Endocrine. 2019;64(2):209–19.

    Article  CAS  PubMed  Google Scholar 

  22. Rochira V. Clinical issues in management of Klinefelter’s syndrome. Meet-the-Professor session, 91st Annual Meeting of the Endocrine Society, Washington, DC; 2009.

    Google Scholar 

  23. Chang S, Skakkebaek A, Trolle C, Bojesen A, Hertz JM, Cohen A, et al. Anthropometry in Klinefelter syndrome—multifactorial influences due to CAG length, testosterone treatment and possibly intrauterine hypogonadism. J Clin Endocrinol Metab. 2015;100(3):E508–17.

    Article  CAS  PubMed  Google Scholar 

  24. Varrela J. Effects of X chromosome on size and shape of body: an anthropometric investigation in 47, XXY males. Am J Phys Anthropol. 1984;64(3):233–42.

    Article  CAS  PubMed  Google Scholar 

  25. Kanakis GA, Nieschlag E. Klinefelter syndrome: more than hypogonadism. Metabolism. 2018;86:135–44.

    Article  CAS  PubMed  Google Scholar 

  26. Ogata T, Matsuo N, Nishimura G. SHOX haploinsufficiency and overdosage: impact of gonadal function status. J Med Genet. 2001;38(1):1–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Han SJ, Kim KS, Kim W, Kim JH, Lee YH, Nam JS, et al. Obesity and hyperglycemia in Korean men with Klinefelter syndrome: the Korean Endocrine Society registry. Endocrinol Metab (Seoul). 2016;31(4):598–603.

    Article  CAS  Google Scholar 

  28. Host C, Skakkebaek A, Groth KA, Bojesen A. The role of hypogonadism in Klinefelter syndrome. Asian J Androl. 2014;16(2):185–91.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Westlander G, Ekerhovd E, Bergh C. Low levels of serum inhibin B do not exclude successful sperm recovery in men with nonmosaic Klinefelter syndrome. Fertil Steril. 2003;79(Suppl 3):1680–2.

    Article  PubMed  Google Scholar 

  30. Smyth CM, Bremner WJ. Klinefelter syndrome. Arch Intern Med. 1998;158(12):1309–14.

    Article  CAS  PubMed  Google Scholar 

  31. Brinton LA. Breast cancer risk among patients with Klinefelter syndrome. Acta Paediatr. 2011;100(6):814–8.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Sansone A, Romanelli F, Sansone M, Lenzi A, Di Luigi L. Gynecomastia and hormones. Endocrine. 2017;55(1):37–44.

    Article  CAS  PubMed  Google Scholar 

  33. Lee YS, Cheng AW, Ahmed SF, Shaw NJ, Hughes IA. Genital anomalies in Klinefelter’s syndrome. Horm Res. 2007;68(3):150–5.

    CAS  PubMed  Google Scholar 

  34. Bojesen A, Juul S, Birkebaek NH, Gravholt CH. Morbidity in Klinefelter syndrome: a Danish register study based on hospital discharge diagnoses. J Clin Endocrinol Metab. 2006;91(4):1254–60.

    Article  CAS  PubMed  Google Scholar 

  35. Skakkebaek A, Wallentin M, Gravholt CH. Neuropsychology and socioeconomic aspects of Klinefelter syndrome: new developments. Curr Opin Endocrinol Diabetes Obes. 2015;22(3):209–16.

    Article  PubMed  Google Scholar 

  36. Ozata M, Yildirimkaya M, Bulur M, Yilmaz K, Bolu E, Corakci A, et al. Effects of gonadotropin and testosterone treatments on lipoprotein(a), high density lipoprotein particles, and other lipoprotein levels in male hypogonadism. J Clin Endocrinol Metab. 1996;81(9):3372–8.

    CAS  PubMed  Google Scholar 

  37. Host C, Bojesen A, Frystyk J, Flyvbjerg A, Christiansen JS, Gravholt CH. Effect of sex hormone treatment on circulating adiponectin and subforms in turner and Klinefelter syndrome. Eur J Clin Invest. 2010;40(3):211–9.

    Article  CAS  PubMed  Google Scholar 

  38. Balestrieri A, Zirilli L, Madeo B, Pignatti E, Rossi G, Carani C, et al. 21-hydroxylase deficiency and klinefelter syndrome in an adult man: striking a balance between androgen excess and insufficiency. J Androl. 2008;29(6):605–9.

    Article  CAS  PubMed  Google Scholar 

  39. Host C, Bojesen A, Erlandsen M, Groth KA, Kristensen K, Jurik AG, et al. A placebo-controlled randomized study with testosterone in Klinefelter syndrome: beneficial effects on body composition. Endocr Connect. 2019;8(9):1250–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Bojesen A, Gravholt CH. Morbidity and mortality in Klinefelter syndrome (47,XXY). Acta Paediatr. 2011;100(6):807–13.

    Article  PubMed  Google Scholar 

  41. Calogero AE, Giagulli VA, Mongioi LM, Triggiani V, Radicioni AF, Jannini EA, et al. Klinefelter syndrome: cardiovascular abnormalities and metabolic disorders. J Endocrinol Invest. 2017;40(7):705–12.

    Article  CAS  PubMed  Google Scholar 

  42. Bojesen A, Birkebaek N, Kristensen K, Heickendorff L, Mosekilde L, Christiansen JS, et al. Bone mineral density in Klinefelter syndrome is reduced and primarily determined by muscle strength and resorptive markers, but not directly by testosterone. Osteoporos Int. 2011;22(5):1441–50.

    Article  CAS  PubMed  Google Scholar 

  43. Balercia G, Bonomi M, Giagulli VA, Lanfranco F, Rochira V, Giambersio A, et al. Thyroid function in Klinefelter syndrome: a multicentre study from KING group. J Endocrinol Invest. 2019;42(10):1199–204.

    Article  CAS  PubMed  Google Scholar 

  44. van den Beld AW, Kaufman JM, Zillikens MC, Lamberts SWJ, Egan JM, van der Lely AJ. The physiology of endocrine systems with ageing. Lancet Diabetes Endocrinol. 2018;6(8):647–58.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Decaroli MC, Rochira V. Aging and sex hormones in males. Virulence. 2017;8(5):545–70.

    Article  CAS  PubMed  Google Scholar 

  46. Pacenza N, Pasqualini T, Gottlieb S, Knoblovits P, Costanzo PR, Stewart Usher J, et al. Clinical presentation of Klinefelter’s syndrome: differences according to age. Int J Endocrinol. 2012;2012:324835.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Andersson AM, Juul A, Petersen JH, Muller J, Groome NP, Skakkebaek NE. Serum inhibin B in healthy pubertal and adolescent boys: relation to age, stage of puberty, and follicle-stimulating hormone, luteinizing hormone, testosterone, and estradiol levels. J Clin Endocrinol Metab. 1997;82(12):3976–81.

    CAS  PubMed  Google Scholar 

  48. Herlihy AS, McLachlan RI, Gillam L, Cock ML, Collins V, Halliday JL. The psychosocial impact of Klinefelter syndrome and factors influencing quality of life. Genet Med. 2011;13(7):632–42.

    Article  PubMed  Google Scholar 

  49. Hanna ES, Cheetham T, Fearon K, Herbrand C, Hudson N, McEleny K, et al. The lived experience of Klinefelter syndrome: a narrative review of the literature. Front Endocrinol (Lausanne). 2019;10:825.

    Article  Google Scholar 

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Correspondence to Vincenzo Rochira .

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De Vincentis, S., Rochira, V. (2020). Phenotype of the Adulthood. In: Garolla, A., Corona, G. (eds) Klinefelter’s Syndrome. Trends in Andrology and Sexual Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-51410-5_14

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  • DOI: https://doi.org/10.1007/978-3-030-51410-5_14

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