A CASE OF GONADAL DYSGENESIS IN A PATIENT WITH A 46/XY KARYOTYPE, PHALLIC ENLARGEMENT AND ABSENCE OF SEMINIFEROUS TUBULES

Among the patients with gonadal dysgenesis, the cases with phallic enlargement, but without the somatic malformations seen in Turner's syndrome, are classified as a special group. This group includes chromatin-negative as well as chromatin-positive cases.

A patient is described with gonadal dysgenesis, XY karyotype, absence of seminiferous tubules in streak gonads, presence of female internal and external genitalia and phallic enlargement.

The problems of sex-determination and differentiation are discussed with regard to this patient.

The XXXXY sex chromosome abnormality

The most common sex chromosome complex in sex chromatin-positive males with Klinefelter's syndrome is XXY. When the complex is XXYY or XXXY, the clinical findings do not seem to differ materially from those seen in XXY subjects, although more patients with these intersexual chromosome complements need to be studied to establish possible phenotypical expressions of the chromosomal variants.Two male children with an XXXXY sex chromosome abnormality are described. The data obtained from the study of these cases and five others described in the literature suggest that the XXXXY patient is likely to have congenital defects not usually seen in the common form of the Klinefelter syndrome. These include a triad of (1) skeletal anomalies (including radioulnar synostosis), (2) hypogenitalism (hypoplasia of penis and scrotum, incomplete descent of testes and defective prepubertal development of seminiferous tubules), and (3) greater risk of severe mental deficiency.That the conclusions are based on data from a small number of patients is emphasized, together with the need for a cytogenetic survey of a large control or unselected population.

The post-nuptial occurrence of progestins in the seminiferous tubules of birds

It has been previously suggested that the cholesterol which appears during the post-nuptial metamorphosis of the seminiferous tubules of submammalian vertebrates may be of endocrine significance. It is now shown by means of paper chromatography that the tubular lipids of pigeons probably contain progesterone and its metabolites. The testes of control ('pre-nuptial') birds contain androgens but no progestins.

Again, the Hooker-Forbes bioassay test indicates the presence of plasma progestins in seven out of eight birds with metamorphosed lipoidal tubules. Of seven control birds in full spermatogenesis six were negative for progestin. The possibility that the regular, post-nuptial accumulation and expenditure of tubular cholesterol is functionally homologous with the formation and regression of the corpus luteum is discussed.

Aspermatogenesis in the guinea pig induced by testicular tissue and adjuvants

The injection into the dorsal skin of a suspension of guinea pig testis or spermia incorporated in a water-in-oil emulsion containing killed mycobacteria induces aspermatogenesis in guinea pigs. The injury begins with the inhibition of the maturation of spermia and proceeds through the degeneration and exfoliation of spermatids, spermatocytes, and finally spermatogonia. These germinal cells pass from the seminiferous tubules into the epididymis. The process is not associated with inflammation. No significant changes occur in the intertubular spaces and the Leydig cells do not seem to be affected. The seminal vesicles and the prostate remain normal. The aspermatogenesis may begin in 10 days and it lasts for more than 5 months. The process may lead to atrophy of the seminiferous tubules and fibrosis. Guinea pigs which receive a suspension of their own testis or spermia and adjuvants develop a similar injury. The "mitochondrial" fraction of the testis of guinea pig is effective while repeated injections of alcoholic extract of testis emulsified with paraffin oil containing mycobacteria do not cause aspermatogenesis. The presence of acid-fast bacilli in the water-in-oil emulsion containing testis or spermia seems to be essential for the production of testicular lesions; the injection of antigen and mycobacteria into different sites is ineffective. When guinea pig testis is replaced by guinea pig liver or kidney or rabbit testis no testicular damage occurs. The injection of rabbit spinal cord combined with adjuvants results in allergic encephalomyelitis in a large proportion of guinea pigs, accompanied by a great loss of weight. The testes of a few of these animals show a varying degree of aspermatogenesis. When guinea pig brain is combined with adjuvants and administered subcutaneously the incidence of testicular injury is high, although the damage is, in general, mild. From the standpoint of mechanism, the inhibition of spermatogenesis which occurs in these animals may be unrelated to the injury which follows the injection of germinal cells. Aspermatogenesis follows the injection of killed mycobacteria in paraffin oil into the testis as well as into certain sites related to the gonad: the abdominal cavity, the subcutaneous tissue over the abdomen, and the skin of the inguinal region. Antibodies fixing complement in the presence of spermia are demonstrable in the sera of guinea pigs injected with testis or spermia and adjuvants. When the mycobacteria are omitted the titers are low and no testicular injury occurs. Although there seems to be a correlation between testicular damage and complement-fixing titer, this may not be a causal relationship. Antibodies which neutralize guinea pig hyaluronidase and those which immobilize spermia have also been demonstrated in the sera of these guinea pigs.