A Case of Klinefelter Syndrome Differentially Diagnosed as a Cause of Gigantism

거인증의 감별진단을 통해 확인된 클라인펠터 증후군 1예

  • Kim, Joo-Young (Department of Internal Medicine, Dongsuwon General Hospital) ;
  • Choi, Yong-Jun (Department of Endocrinology and Metabolism, Ajou University School of Medicine) ;
  • Rhee, Sang-Youl (Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine)
  • 김주영 (동수원병원 내과) ;
  • 최용준 (아주대학교 의과대학 내분비대사내과) ;
  • 이상열 (경희대학교 의과대학 내분비대사내과)
  • Published : 2011.03.01

Abstract

Klinefelter syndrome is a congenital disease that is associated with the existence of an extra X chromosome, and is one of the most common causes of male primary hypogonadism. In addition to hypogonadism-associated manifestations such as testicular atrophy and infertility, it is also well known that this syndrome may be associated with other systemic comorbidities. In this report, we describe a typical case of Klinefelter syndrome that was differentially diagnosed as a cause of gigantism. A 20-year-old male was admitted to evaluate the cause of tall stature. His height was 193.4 cm, and all screening tests for gigantism were negative. Physical examination revealed no clear evidence of secondary sexual characteristics, and the results of a hormonal assay were highly suspicious for primary hypogonadism. Based on these findings, we performed a chromosomal analysis and confirmed Klinefelter syndrome with a 47, XXY karyotype.

클라인펠터 증후군은 잉여의 X염색체 존재에 의한 선천성 질환으로 남성의 일차성 성선기능저하증을 유발하는 가장 흔한 원인의 하나이다. 이는 고환 위축, 불임 등의 성선기능저하증과 관련된 증상 이외에도 여러 다양한 합병증을 동반하는 것으로 잘 알려져 있다. 저자들은 군 복무 중인 환자에서 거인증에 대한 감별진단을 통해 확진된 클라인펠터 증후군 환자를 경험하여 이를 보고하고자 한다. 20세 남자 환자가 지속적으로 키가 커지는 증상으로 내원하였다. 환자의 신장은 193.4 cm로 거인증과 관련된 다른 원인들에 대한 감별진단을 시행하였으나 모두 정상이었다. 하지만 환자의 신체 검사상 이차 성징의 증거가 뚜렷하지 않았고 호르몬 검사상 일차성 성선기능저하증이 의심되었다. 이에 염색체 핵형 검사를 시행하여 47, XXY의 클라인펠터 증후군으로 확진되었다.

Keywords

References

  1. Schwartz ID, Root AW. The Klinefelter syndrome of testicular dysgenesis. Endocrinol Metab Clin North Am 1991;20:153-163.
  2. Bojesen A, Juul S, Gravholt CH. Prenatal and postnatal prevalence of Klinefelter syndrome: a national registry study. J Clin Endocrinol Metab 2003;88:622-626. https://doi.org/10.1210/jc.2002-021491
  3. Daniel D, Federman, Robert E. Scully. Case 44-1965-chronic pulmonary disease in a eunuchoid patient. N Engl J Med 1965; 273:816-823. https://doi.org/10.1056/NEJM196510072731510
  4. Weiss JR, Moysich KB, Swede H. Epidemiology of male breast cancer. Cancer Epidemiol Biomarkers Prev 2005;14:20-26.
  5. Swerdlow AJ, Schoemaker MJ, Higgins CD, Wright AF, Jacobs PA. Cancer incidence and mortality in men with Klinefelter syndrome: a cohort study. J Natl Cancer Inst 2005;97:1204-1210. https://doi.org/10.1093/jnci/dji240
  6. Swerdlow AJ, Hermon C, Jacobs PA, et al. Mortality and cancer incidence in persons with numerical sex chromosome abnormalities: a cohort study. Ann Hum Genet 2001;65:177-188. https://doi.org/10.1046/j.1469-1809.2001.6520177.x
  7. Kim CW, Lee MY, Nam SM, et al. A case of Klinefelter's syndrome associated with idiopathic thrombocytopenic purpura. Korean J Med 2007;72:241-243.
  8. Abramsky L, Chapple J. 47,XXY (Klinefelter syndrome) and 47,XYY: estimated rates of and indication for postnatal diagnosis with implications for prenatal counselling. Prenat Diagn 1997;17: 363-368. https://doi.org/10.1002/(SICI)1097-0223(199704)17:4<363::AID-PD79>3.0.CO;2-O
  9. Lanfranco F, Kamischke A, Zitzmann M, Nieschlag E. Klinefelter's syndrome. Lancet 2004;364:273-283. https://doi.org/10.1016/S0140-6736(04)16678-6
  10. Paulsen CA, Gordon DL, Carpenter RW, Gandy HM, Drucker WD. Klinefelter's syndrome and its variants: a hormonal and chromosomal study. Recent Prog Horm Res 1968;24:321-363.
  11. Lee SU, Baek HJ, Han DK, et al. A case of 47, XXY/46, XX/46, XY Mosaic Klinefelter syndrome with mediastinal germ cell tumor. Clin Pediatr Hematol-Oncol 2007;14:83-88.
  12. Park EY, Moon SJ. 49, XXXXY syndrome with multicystic kidney in a neonate. J Korean Pediatr Soc 2001;44:714-717.
  13. Cho IR, Lee MS. Klinefelter's syndrome: 87 cases. Korean J Urol 1991;32:642-648.
  14. Zinn AR, Ramos P, Elder FF, Kowal K, Samango-Sprouse C, Ross JL. Androgen receptor CAGn repeat length influences phenotype of 47,XXY (Klinefelter) syndrome. J Clin Endocrinol Metab 2005;90:5041-5046. https://doi.org/10.1210/jc.2005-0432
  15. Wang C, Baker HW, Burger HG, De Kretser DM, Hudson B. Hormonal studies in Klinefelter's syndrome. Clin Endocrinol (Oxf) 1975;4:399-411. https://doi.org/10.1111/j.1365-2265.1975.tb01547.x
  16. Simm PJ, Zacharin MR. The psychosocial impact of Klinefelter syndrome-a 10 year review. J Pediatr Endocrinol Metab 2006; 19:499-505.
  17. Ross JL, Roeltgen DP, Stefanatos G, et al. Cognitive and motor development during childhood in boys with Klinefelter syndrome. Am J Med Genet A 2008;146A:708-719. https://doi.org/10.1002/ajmg.a.32232
  18. Volkl TM, Langer T, Aigner T, et al. Klinefelter syndrome and mediastinal germ cell tumors. Am J Med Genet A 2006;140: 471-481.