A Unique Intersection: Exploring Cerebral Anomalies in Klinefelter Syndrome

Document Type : Case Report

Authors

1 ENT and Head and Neck Research Center, Department Of Otolaryngology, Head and Neck Surgery, Hazrat Rasoul Akram Hospital, Iran University Of Medical Science (IUMS), Tehran, Iran

2 Department of Medicine, Najafabad Branch, Islamic Azad University, Najaf Abad, Iran

3 Department of Radiology, Loghman e Hakim Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran

Abstract

Background: Klinefelter syndrome (KS) is the most prevalent sex-chromosome aberration and the leading genetic cause of male hypogonadism. This chromosomal anomaly results in male hypergonadotropic hypogonadism, androgen deficiency, impaired spermatogenesis, and cognitive impairment. On the other hand holoprosencephaly (HPE) is a complex developmental disorder that represents a profound malformation of the human brain, characterized by the failure of midline cleavage of the prosencephalon into the right and left hemispheres.
Case Report: The study presents a unique clinical scenario involving the co-occurrence of alobar holoprosencephaly (HPE) and Klinefelter syndrome (KS) in a term male fetus born to a healthy couple with uneventful prenatal ultrasound studies. While Klinefelter syndrome is known for its chromosomal aberrations, the simultaneous presence of HPE raises intriguing questions regarding the potential association between KS and cerebral malformations.
Conclusion: This case highlights the importance of further research to explore the underlying mechanisms and implications of this rare intersection, shedding light on previously uncharted territory in the realm of genetic and neurodevelopmental disorders.
 
 

Keywords


  1. DeMyer W, Zeman W, Palmer CG. The face predicts the brain: diagnostic significance of median facial anomalies for holoprosencephaly (arhinencephaly). Pediatrics. 1964;34(2):256-63.
  2. Dubourg C, Bendavid C, Pasquier L, Henry C, Odent S, David V. Holoprosencephaly. Orphanet J Rare Dis. 2007;2(1):1-4.
  3. Croen LA, Shaw GM, Lammer EJ. Holoprosencephaly: epidemiologic and clinical characteristics of a California population. Am J Med Genet. 1996;64(3):465-72.
  4. Solomon BD, Gropman A, Muenke M. Holoprosencephaly Overview. 2000. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle. 2019.
  5. DeMyer W, Zeman W, Palmer CG. The face predicts the brain: diagnostic significance of median facial anomalies for holoprosencephaly (arhinencephaly). Pediatrics. 1964;34(2):256-63.
  6. Delezoide AL, Narcy F, Larroche JC. Cerebral midline developmental anomalies: spectrum and associated features. Genetic Counseling (Geneva, Switzerland). 1990;1(3-4):197-10.
  7. Bendavid C, Dupé V, Rochard L, Gicquel I, Dubourg C, David V. Holoprosencephaly: an update on cytogenetic abnormalities. Am J Med Genet C Semin Med Genet. 2010;154(1):86-92. Hoboken: Wiley Subscription Services, Inc., A Wiley Company.
  8. Barr Jr M, Hanson JW, Currey K, Sharp S, Toriello H, Schmickel RD, et al. Holoprosencephaly in infants of diabetic mothers. J Pediatr. 1983;102(4):565-8.
  9. Chen CP, Su TH, Chern SR, Su JW, Lee CC, Wang W. Alobar holoprosencephaly, cebocephaly, and micropenis in a Klinefelter fetus of a diabetic mother. Taiwan J Obstet Gynecol. 2012;51(4):630-4.
  10. Croen LA, Shaw GM, Lammer EJ. Risk factors for cytogenetically normal holoprosencephaly in California: A population‐based case‐control study. Am J Med Genet. 2000;90(4):320-5.
  11. Repetto M, Maziere JC, Citadelle D, Dupuis R, Meier M, Biade S, et al. Teratogenic effect of the cholesterol synthesis inhibitor AY 9944 on rat embryos in vitro. Teratology. 1990;42(6):611-8.
  12. Frenkel LD, Gaur S, Tsolia M, Scudder R, Howell R, Kesarwala H. Cytomegalovirus infection in children with AIDS. Rev Infect Dis. 1990;12(Supplement 7):S820-6.
  13. Byrne PJ, Silver MM, Gilbert JM, Cadera W, Tanswell AK, Reynolds JF. Cyclopia and congenital cytomegalovirus infection. Am J Med Genet. 1987;28(1):61-5.
  14. Lison MP, Armbrust-Figueiredo J, Mega D. Arhinencephalia: considerations apropos of a case diagnosed during life. Acta Neurol Psychiatr Belg. 1967;67(1):25-36.
  15. Castel Y, Riviere D, Toudic L, Nouaille Y, L'Henoret J, Duparcmeur H, et al. Two cases of cyclopia. InAnnales de pediatrie 1976;23(10):647-51.
  16. Probst C. Cerebral edema: neurosurgical aspects of pathological, diagnostic and therapeutic problems (author's transl). Schweiz Rundsch Med Prax. 1976;65(31):948-56.
  17. Roessler E, Muenke M. Holoprosencephaly: a paradigm for the complex genetics of brain development. J Inherit Metab Dis. 1998;21(5):481-97.
  18. Wikström AM, Dunkel L. Klinefelter syndrome. Best Pract Res Clin Endocrinol Metab. 2011;25(2):239-50.
  19. Groth KA, Skakkebæk A, Høst C, Gravholt CH, Bojesen A. Klinefelter syndrome—a clinical update. J Clin Endocrinol Metab. 2013;98(1):20-30.
  20. Klinefelter Jr HF, Reifenstein Jr EC, Albright Jr F. Syndrome characterized by gynecomastia, aspermatogenesis without A-Leydigism, and increased excretion of follicle-stimulating hormone. J Clin Endocrinol Metab. 1942;2(11):615-27.
  21. Swerdlow AJ, Higgins CD, Schoemaker MJ, Wright AF, Jacobs PA, United Kingdom Clinical Cytogenetics Group. Mortality in patients with Klinefelter syndrome in Britain: a cohort study. J Clin Endocrinol Metab. 2005;90(12):6516-22.
  22. Smyth CM, Bremner WJ. Klinefelter syndrome. Arch Intern Med. 1998;158(12):1309-14.
  23. Schnabel R, Hansen S. Karyotype 47, XXY, 18p‐in a newborn child with holoprosencephaly. Clin Genet. 1983;23(3):186-90.
  24. Chen TH, Chao MC, Lin LC, Jong YJ, Lai YH, Chen HL. Aicardi syndrome in a 47, XXY male neonate with lissencephaly and holoprosencephaly. J Neurol Sci. 2009;278(1-2):138-40.
  25. Armbruster‐Moraes E, Schultz R, Brizot MD, Miyadahira S, Zugaib M. Holoprosencephaly in a Klinefelter fetus. Am J Med Genet. 1999;85(5):511-2.
  26. Abdollahifakhim S, Sakhinia E, Mousaviagdas M. Holoprosencephaly and Klinefelter syndrome. Iran J Pediatr. 2014;24(2):227-8.
  27. Berry SM, Gosden CM, Snijders RJ, Nicolaides KH. Fetal holoprosencephaly: associated malformations and chromosomal defects. Fetal Diagn Ther. 1990;5(2):92-9.
  28. Chen CP. Perinatal identification of caudal regression syndrome and alobar holoprosencephaly in pregnancies with poor maternal metabolic control. Genet Couns. 2004;15(4):485-8.
  29. Chen CP, Chen CY, Lin CY, Shaw SW, Wang W, Tzen CY. Prenatal diagnosis of concomitant alobar holoprosencephaly and caudal regression syndrome associated with maternal diabetes. Prenat Diagn. 2005;25(3):264-6.
  30. Capobianco G, Cherchi PL, Ambrosini G, Cosmi E, Andrisani A, Dessole S. Alobar holoprosencephaly, mobile proboscis and trisomy 13 in a fetus with maternal gestational diabetes mellitus: a 2D ultrasound diagnosis and review of the literature. Arch Gynecol Obstet. 2007;275(5):385-7.
  31. Cohen Jr MM, Shiota K. Teratogenesis of holoprosencephaly. Am J Med Genet. 2002;109(1):1-5.
  32. Ornoy A, Reece EA, Pavlinkova G, Kappen C, Miller RK. Effect of maternal diabetes on the embryo, fetus, and children: congenital anomalies, genetic and epigenetic changes and developmental outcomes. Birth Defects Res. C Embryo Today. 2015;105(1):53-72.
  33. Johnson CY, Rasmussen SA. Non‐genetic risk factors for holoprosencephaly. Am J Med Genet C Semin Med Genet. 2010;154(1):73-85. Hoboken: Wiley Subscription Services, Inc., A Wiley Company.
  34. Lehman CD, Nyberg DA, Winter 3rd TC, Kapur RP, Resta RG, Luthy DA. Trisomy 13 syndrome: prenatal US findings in a review of 33 cases. Radiology. 1995;194(1):217-22.
  35. Nicolaides KH, Snijders RJ, Campbell S, Gosden CM, Berry C. Ultrasonographically detectable markers of fetal chromosomal abnormalities. The Lancet. 1992;340(8821):704-7.
  36. Corsello G, Buttitta P, Cammarata M, Lo Presti A, Maresi E, Zumpani L, et al. Holoprosencephaly: examples of clinical variability and etiologic heterogeneity. Am J Med Genet. 1990;37(2):244-9.
  37. McGahan JP, Nyberg DA, Mack LA. Sonography of facial features of alobar and semilobar holopro-sencephaly. Am J Roentgenol. 1990;154(1):143-8.
  38. Belloni E, Muenke M, Roessler E, Traverse G, Siegel-Bartelt J, Frumkin A, et al. Identification of Sonic hedgehog as a candidate gene responsible for holoprosencephaly. Nat Genet. 1996;14(3):353-6.
  39. Ming JE, Muenke M. Holoprosencephaly: from Homer to hedgehog. Clin Genet. 1998;53(3):155-63.
  40. Ming JE, Roessler E, Muenke M. Human developmental disorders and the Sonic hedgehog pathway. Mol Med Today. 1998;4(8):343-9.
  41. Lanfranco F, Kamischke A, Zitzmann M, Nieschlag E. Klinefelter's syndrome. The Lancet. 2004 Jul 17;364(9430):273-83.