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Maqdasy S, Barres B, Salaun G, Batisse-Lignier M, Pebrel-Richard C, Kwok KHM, Labbé A, Touraine P, Brugnon F, Tauveron I. Idiopathic central precocious puberty in a Klinefelter patient: highlights on gonadotropin levels and pathophysiology. Basic Clin Androl 2020; 30:19. [PMID: 33292161 PMCID: PMC7724694 DOI: 10.1186/s12610-020-00117-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/04/2020] [Indexed: 11/22/2022] Open
Abstract
Background Idiopathic central precocious puberty (ICPP) is supposed to be non-existent in a context of testicular destruction that is typically present in Klinefelter syndrome (KS). Herein, we describe a rare case of ICPP in a Klinefelter patient (47,XXY) with 2 maternal X chromosomes. Moreover, we highlight the differences in gonadotropin levels in comparison to males with ICPP and a normal karyotype. Case presentation An 8 years old boy with a history of cryptorchidism was evaluated for precocious puberty (Tanner staging: P2/G3). Both testes measured 25x35mm. His hormonal profile confirmed a central origin of precocious puberty with high serum testosterone (4.3 ng/ml), luteinizing hormone [LH (3.5 UI/l)] and follicle stimulating hormone [FSH (7.7 UI/l)] levels. Luteinizing hormone-releasing hormone (LHRH) test amplified LH and FSH secretion to 24 and 14 UI/l respectively. Brain magnetic resonance imaging (MRI) was normal. No MKRN3 mutation was detected. He was treated for ICPP for two years. During puberty, he suffered from hypergonadotropic hypogonadism leading to the diagnosis of KS (47,XXY karyotype). Chromosomal analysis by fluorescent multiplex polymerase chain reaction (PCR) using X chromosome microsatellite markers identified 2 maternal X chromosomes. Analysing 8 cases of KS developing ICPP (our reported case and 7 other published cases) revealed that these KS patients with ICPP have higher LH and FSH levels during ICPP episode than in ICPP patients with a normal karyotype (ICPP with KS vs ICPP with a normal karyotype: LH levels 9.4 ± 12 vs 1.1 ± 0.6 UI/l; FSH levels 23.1 ± 38.5 vs 2.7 ± 1.5 UI/l). Furthermore, their response to gonadotropin-releasing hormone (GnRH) stimulation is characterized by excessive LH and FSH secretion (LH levels post-GnRH: 58 ± 48 vs 15.5 ± 0.8 UI/l; FSH levels post-GnRH: 49.1 ± 62.1 vs 5.7 ± 3.9 UI/l). Conclusions ICPP in boys is extremely rare. The pathophysiology of ICPP in KS is unknown. However, maternal X supplementary chromosome and early testicular destruction may play a significant role in the initiation of ICPP, in part explaining the relative “overrepresentation of ICPP in KS. Thus, karyotype analysis could be considered for boys suffering from ICPP, especially if testicular size is smaller or gonadotropins are significantly elevated. Supplementary Information The online version contains supplementary material available at 10.1186/s12610-020-00117-1.
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Affiliation(s)
- Salwan Maqdasy
- CHU Clermont-Ferrand, Service d'endocrinologie, diabétologie et maladies métaboliques, 58, rue Montalembert, F-63003, Clermont-Ferrand, France. .,Université Clermont Auvergne, Faculté de médecine, F-63003, Clermont-Ferrand, France. .,Laboratoire GReD, Université Clermont Auvergne, F-63003, Clermont-Ferrand, France.
| | - Bertrand Barres
- Centre Jean Perrin, Service de Médecine nucléaire, F-63003, Clermont-Ferrand, France
| | - Gaelle Salaun
- CHU Clermont-Ferrand, service de cytogénétique médicale, F-63003, Clermont-Ferrand, France
| | - Marie Batisse-Lignier
- CHU Clermont-Ferrand, Service d'endocrinologie, diabétologie et maladies métaboliques, 58, rue Montalembert, F-63003, Clermont-Ferrand, France
| | - Celine Pebrel-Richard
- CHU Clermont-Ferrand, service de cytogénétique médicale, F-63003, Clermont-Ferrand, France
| | - Kelvin H M Kwok
- Department of Biosciences and Nutrition, Karolinska Institutet, 141 83, Stockholm, Sweden
| | - André Labbé
- CHU Clermont-Ferrand, Service de pédiatrie, F-63003, Clermont-Ferrand, France
| | - Philippe Touraine
- Hôpital Pitié-Salpêtrière, service d'endocrinologie et médecine de la reproduction, Centre de maladies endocriniennes rares de la croissance et du développement, Paris, France
| | - Florence Brugnon
- Université Clermont Auvergne, Faculté de médecine, F-63003, Clermont-Ferrand, France.,Assistance Médicale à la Procréation, CECOS, CHU Clermont-Ferrand, F-63000, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, CHU Clermont-Ferrand, F-63000, Clermont Ferrand, France
| | - Igor Tauveron
- CHU Clermont-Ferrand, Service d'endocrinologie, diabétologie et maladies métaboliques, 58, rue Montalembert, F-63003, Clermont-Ferrand, France.,Université Clermont Auvergne, Faculté de médecine, F-63003, Clermont-Ferrand, France.,Laboratoire GReD, Université Clermont Auvergne, F-63003, Clermont-Ferrand, France
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