Klinefelter syndrome (KS) is a sex chromosomal anomaly, which in most cases is characterized by 47 chromosomes instead of the usual 46.
The estimated incidence is 0.15-0.2% of live births.
- the testes are normal prior to puberty and small in post pubertal testes; there is absent spermatogenesis
- the kidneys may be symmetrically enlarged with small 1-8 mm cysts
- post pubertal gynecomastia
- sparse facial and axillary hair
- tall stature
- narrow shoulders
- broad hips
- normal to moderately reduced Leydig cell function
- increased secretion of follicle-stimulating hormone
- androgen deficiency
- normal to slightly decreased verbal intelligence
- ~80% have 47XXY
- ~10% have mosaic 46XY/47XXY
- ~10% have 48XXYY and other less frequent types
These abnormal divisions occur as sporadic events and are not hereditary.
Klinefelter syndrome should be suspected in postpubertal males with bilateral symmetrical small testicular volume (usually 3~4 mL in volume) with ultrasonography, usually presented by subfertility/primary infertility or assessment of small testicular size and karyotyping should be recommended 7. However, Klinefelter syndrome is often overlooked or untreated.
Treatment and prognosis
Early recognition and hormonal treatment can improve quality of life and prevent serious complications. Testosterone replacement is mainly for androgen deficiency but does not improve infertility 7.
- increased incidence of male breast malignancy
- increased incidence of germ cell tumors, particularly in the mediastinum 6.
History and etymology
It is named after Harry Klinefelter (1912-1990) 8 who first described the syndrome in 1942.
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- 6. Curry WA, McKay CE, Richardson RL, Greco FA. Klinefelter's syndrome and mediastinal germ cell neoplasms. J Urol. 1981 Jan;125(1):127-9. Pubmed citation
- 7. Nieschlag E. Klinefelter syndrome: the commonest form of hypogonadism, but often overlooked or untreated. (2013) Deutsches Arzteblatt international. 110 (20): 347-53. doi:10.3238/arztebl.2013.0347 - Pubmed
- 8. Harry F. Klinefelter: 1912–1990. (2009) The Endocrinologist. 19 (1): 1. doi:10.1097/TEN.0b013e318197bead