Genetics and Immunology · Reproductive Genetics

New developments and future trajectories in supernumerary sex chromosome abnormalities: a summary of the 2022 3rd International Workshop on Klinefelter Syndrome, Trisomy X, and XYY

Gravholt CH, Ferlin A, Gromoll J, Juul A, Raznahan A, van Rijn S, Rogol AD, Skakkebæk A, Tartaglia N, Swaab H

Published March 2023 Endocrine connections
DOI 10.1530/ec-22-0500 PMID 36598290 PMC PMC9986408

RRM Academy Synopsis

Extra sex chromosomes may affect fertility and brain development

Extra sex chromosome syndromes carry an increased risk of developmental and behavior problems and can affect fertility. This comes from a summary of a 2022 expert workshop on 47,XYY syndrome, Klinefelter syndrome and trisomy X. Participants agreed on a plan for new Klinefelter care guidelines.

Key Findings

  • Many studies found lower bone density in men with Klinefelter syndrome, along with less muscle and more fat. No study has shown that testosterone replacement lowers their fracture rate.
  • The workshop summary reports that testicular sperm extraction recovers sperm at a rate of about 40% in men with Klinefelter syndrome.
  • In 47,XYY syndrome, puberty, testicular tissue and sperm production are most often normal. In trisomy X syndrome, primary ovarian insufficiency is more common than in controls.
  • Two studies of very young children found early signs of neurocognitive and behavioral diagnoses in the first years of life. Both found more similarities than differences between the three syndromes.
  • Advocacy groups said most countries have no health care system that diagnoses these syndromes. For males with Klinefelter syndrome or 47,XYY syndrome, the life course includes late diagnosis and many undiagnosed cases.

Interpretation

The paper is a summary of keynote talks at an expert workshop. The authors also acknowledge oral and poster talks that the summary does not cover. Most of the evidence concerns Klinefelter syndrome. The authors call research on 47,XYY syndrome and trisomy X limited. They judged guidelines for those syndromes premature because data are insufficient. The fracture benefit of testosterone treatment comes from reasoning about other hypogonadal conditions and from observational work.

RRM Context

Restorative reproductive medicine evaluates both partners. Klinefelter syndrome is a genetic cause that such an evaluation can find. In males with it, the paper describes late diagnosis and many undiagnosed cases. In trisomy X, adolescents have low anti-Mullerian hormone levels. The paper calls their meaning for later fertility unclear.

Abstract

The 3rd International Workshop on Klinefelter Syndrome, Trisomy X, and 47,XYY syndrome was held in Leiden, the Netherlands, on September 12-14, 2022. Here, we review new data presented at the workshop and discuss scientific and clinical trajectories. We focus on shortcomings in knowledge and therefore point out future areas for research. We focus on the genetics and genomics of supernumerary sex chromosome syndromes with new data being presented. Most knowledge centre specifically on Klinefelter syndrome, where aspects on testosterone deficiency and the relation to bone, muscle and fat were discussed, as was infertility and the treatment thereof. Both trisomy X and 47,XYY syndrome are frequently affected by infertility. Transitioning of males with Klinefelter syndrome was addressed, as this seemingly simple process in practise is often difficult. It is now realized that neurocognitive changes are pervasive in all supernumerary sex chromosome syndromes, which were extensively discussed. New intervention projects were also described, and exciting new data concerning these were presented. Advocacy organizations were present, describing the enormous burden carried by parents when having to explain their child's specific syndrome to most professionals whenever in contact with health care and education systems. It was also pointed out that most countries do not have health care systems that diagnose patients with supernumerary sex chromosome syndromes, thus pinpointing a clear deficiency in the current genetic testing and care models. At the end of the workshop, a roadmap towards the development of new international clinical care guidelines for Klinefelter syndrome was decided.

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Genetics and Immunology › Reproductive Genetics › Chromosomal Abnormalities
Claus H Gravholt, Alberto Ferlin, Joerg Gromoll, Anders Juul, Armin Raznahan, Sophie van Rijn, Alan D Rogol, Anne Skakkebæk, Nicole Tartaglia, Hanna Swaab
C Gravholt, A Ferlin, J Gromoll, A Juul, A Raznahan, S Rijn, A Rogol, A Skakkebæk, N Tartaglia, H Swaab
PMID 36598290 36598290 DOI 10.1530/ec-22-0500 10.1530/ec-22-0500 Gravholt et al. 2023, Gravholt 2023