Background: Klinefelters syndrome (KS) is the most prevalent chromosomal abnormality and clinically characterized by oligo-azoospermia, hypergonadotropic hypogonadism, gynecomastia and infertility in adults. Genital malformations in KS have rarely been reported.
Objective and hypotheses: To investigate the etiology of penoscrotal hypospadias in a 14-month-old boy.
Method: The patient was born from a healthy 23-year-old mother after in-vitro fertilization. Prenatal screening tests were normal, no chronic illness present and no drug used. Parents were no relatives. Thirty three-year-old father had subclinical hypothyroidism and azoospermia. Physical examination of the case revealed a height of 82 cm (S.D. score 1.50), weight 16.2 kg (S.D. score 3.4), penoscrotal hypospadias, and ventral chordee abnormality with bilateral normal testes (2/2 ml).
Results: Laboratory studies showed normal biochemistry, follicle stimulating hormone 1.37 mIU/ml (normal range, 0.34.6 mIU/ml), luteinizing hormone <0.2 mIU/ml (normal range, 0.040.42 mIU/ml), total testosterone <0.1 ng/ml (normal range <0.2 ng/ml). Pelvic ultrasonography revealed no ovarian and uterine tissue. Following human chorionic gonadotropin administration, total testosterone increased to 1.32 ng/ml indicating normal androgen synthesis. Chromosomal analysis revealed 47,XXY karyotype. Further genetic investigation disclosed a known missense mutation in AR (p.p392S, c.1174C>T). Results of genetic analyses of the parents are pending.
Conclusion: Although KS is suggested to be in the differential diagnosis of penoscrotal abnormalities, mutations in genes involved in androgen synthesis or responsiveness should also be investigated.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology