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The Expert in the Room

Article Title: The Expert in the Room: Parental Advocacy for Children with Sex Chromosome Aneuploidies

Authors: Richardson, Riggan, and Allyse

Date of Publication: November 2, 2020

“Owing to fragmentation in the medical system, many parents of children with disabilities report taking on a care coordinator and advocate role. The parental advocacy and care coordination requirements are further amplified in this population because of a lack of awareness about sex chromosome aneuploidies (SCAs) in medical and social services settings, as well as the complex needs of affected children. This burden disproportionately affects mothers and low-resource families as a result of gendered ideas of parenthood and social stratification in resource access. The aim of this study is to understand the unique parental burdens of SCAs and family support needs.”

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Metabolic and cardiovascular risk factors in Klinefelter syndrome

Article Title: Metabolic and cardiovascular risk factors in Klinefelter syndrome

Authors: Spaziani and Radicioni

Date of Publication: June 2020

“Klinefelter syndrome (KS), which normally presents with a 47,XXY karyotype, is the most common sex chromosome disorder in males. It is also the most common genetic cause of male infertility. KS subjects are typically tall, with small and firm testes, gynecomastia, broad hips, and sparse body hair, although a less evident presentation is also possible. KS is also characterized by a high prevalence of hypogonadism, metabolic syndrome (MetS) and cardiovascular disease. The aim of this article is to systematically review metabolic and the cardiovascular risk factors in KS patients. Hypogonadism has an important role in the pathogenesis of the changes in body composition (particularly visceral obesity) and hence of insulin resistance and MetS, but the association between KS and MetS may go beyond hypogonadism alone. From childhood, KS patients may show an increase in visceral fat with a reduction in lean body mass and an increase in glucose and impaired fat metabolism. Their increased incidence of congenital anomalies, epicardial adipose tissue, and thromboembolic disease suggests they have a higher risk of cardiovascular disease. There is conflicting evidence on the effects of testosterone therapy on body composition and metabolism.”

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2020-11-05T15:04:15-05:00Categories: 47,XXY (Klinefelter)|

Minipuberty in Klinefelter syndrome: Current status and future directions

Article Title: Minipuberty in Klinefelter syndrome: Current status and future directions

Authors: Aksglaede, Davis, Ross, and Juul

Date of Publication: June 2020

“Klinefelter syndrome is highly underdiagnosed and diagnosis is often delayed. With the introduction of non-invasive prenatal screening, the diagnostic pattern will require an updated description of the clinical and biochemical presentation of infants with Klinefelter syndrome. In the first months of life, the hypothalamic–pituitary–gonadal (HPG)-axis is transiently activated in healthy males during the so-called minipuberty. This period represents a “window of opportunity” for evaluation of the HPG-axis before puberty and without stimulation tests. Infants with Klinefelter syndrome present with a hormonal surge during the minipuberty. However, only a limited number of studies exist, and the results are contradictory. Further studies are needed to clarify whether infants with Klinefelter syndrome present with impaired testosterone production during the minipuberty. The aim of this review is to describe the clinical and biochemical characteristics of the neonate and infant with Klinefelter syndrome with special focus on the minipuberty and to update the clinical recommendations for Klinefelter syndrome during infancy.”

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2020-11-05T14:58:50-05:00Categories: 47,XXY (Klinefelter)|

Psychological functioning, brain morphology, and functional neuroimaging in Klinefelter syndrome

Article Title: Psychological functioning, brain morphology, and functional neuroimaging in Klinefelter syndrome

Authors: Skakkebæk, Gravholt, Chang, Moore, and Wallentin

Date of Publication: June 2020

“Klinefelter syndrome (KS; 47,XXY) impacts neurodevelopment and is associated with an increased risk of cognitive, psychological and social impairments, although significant heterogeneity in the neurodevelopmental profile is seen. KS is characterized by a specific cognitive profile with predominantly verbal deficits, preserved function in non-verbal and visuo-spatial domains, executive dysfunction and social impairments, and by an increased vulnerability toward psychiatric disorders. The neurobiological underpinnings of the observed neuropsychological profile have not been established. A distinct pattern of both global and regional brain volumetric differences has been demonstrated in addition to preliminary findings of functional brain alterations related to auditory, motor, language and social processing. When present, the combination of cognitive, psychological and social challenges has the potential to negatively affect quality of life. This review intends to provide information and insight to the neuropsychological outcome and brain correlates of KS. Possible clinical intervention and future directions of research will be discussed.”

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2020-11-05T14:39:25-05:00Categories: 47,XXY (Klinefelter)|

Executive function in XXY: Comparison of performance-based measures and rating scales

Article Title: Executive function in XXY: Comparison of performance-based measures and rating scales

Authors: Janusz, Harrison, C. Boada, Cordeiro, Howell, Tartaglia, and R. Boada

Date of Publication: June 2020

“Few studies have systematically assessed executive functioning (EF) skills in boys with XXY, and these are limited by small samples and restricted EF assessment. This study used a broader battery of performance-based measures as well as parent-rating scales of EF in 77 boys and adolescents with XXY (mean age = 12.5 years), recruited from a clinical trial and an outpatient clinic. Exploratory factor analyses were used to create EF domains from performance-based measures, and similar domains were measured using the Behavior Rating Inventory of Executive Function and Conners Parent-Rating Scales. The boys with XXY showed a distinct EF profile, with the greatest deficit in attention and more moderate deficits in working memory, switching, and planning/ problem solving. Parent ratings showed similar challenges, as well as impaired inhibition. Independent sample t-tests showed no difference on performance measures between boys diagnosed or not diagnosed with attention-deficit/hyperactivity disorder (ADHD), although parents of boys diagnosed with ADHD reported more difficulties. There were no differences on performance-based tests between those diagnosed pre- and postnatally, although parents of postnatally diagnosed boys reported more metacognitive problems. Language deficits, cognition, and socio-economic status did not account for EF deficits.”

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2020-11-05T13:05:33-05:00Categories: 47,XXY (Klinefelter)|Tags: |

High prevalence of cardiometabolic risk features in adolescents with 47,XXY/Klinefelter syndrome

Article Title: High prevalence of cardiometabolic risk features in adolescents with 47,XXY/Klinefelter syndrome

Authors: Davis, DeKlotz, Nadeau, Kelsey, Zeitler, and Tartaglia

Date of Publication: June 2020

“Klinefelter syndrome (KS) occurs in 1:600 males and is associated with high morbidity and mortality due to diabetes and cardiovascular disease. Up to 50% of men with KS have metabolic syndrome, a cluster of features conferring increased risk for diabetes and cardiovascular disease. These cardiometabolic (CM) risk features have not been studied in adolescents with KS. The objective of this cohort study was to compare CM risk features in adolescents with KS to controls matched for sex, age, and BMI z score.”

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2020-11-05T12:49:50-05:00Categories: 47,XXY (Klinefelter)|

Diminished Ovarian Reserve in Girls and Adolescents with Trisomy X Syndrome

Article Title: Diminished Ovarian Reserve in Girls and Adolescents with Trisomy X Syndrome

Authors: Davis, Soares, Howell, Cree-Green, Buyers, Johnson, and Tartaglia

Date of Publication: June 2020

“An extra X chromosome occurs in ~ 1 in 1000 females, resulting in a karyotype 47,XXX also known as trisomy X syndrome (TXS). Women with TXS appear to be at increased risk for premature ovarian insufficiency; however, very little research on this relationship has been conducted. The objective of this case-control study is to compare ovarian function, as measured by anti-mullerian hormone (AMH) levels, between girls with TXS and controls. Serum AMH concentrations were compared between 15 females with TXS (median age 13.4 years) and 26 controls (median age 15.1 years). Females with TXS had significantly lower serum AMH compared to controls (0.7 ng/mL (IQR 0.2–1.7) vs 2.7 (IQR 1.3–4.8), p < 0.001). Additionally, girls with TXS were much more likely to have an AMH below the 2.5th percentile for age with 67% of them meeting these criteria (OR 11, 95% CI 2.3–42). Lower AMH concentrations in females with TXS may represent an increased risk for primary ovarian insufficiency in these patients and potentially a narrow window of opportunity to pursue fertility preservation options. Additional research is needed to understand the natural history of low AMH concentrations and future risk of premature ovarian insufficiency in girls with TXS.”

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2020-11-03T14:56:22-05:00Categories: 47,XXX (trisomy x)|

AXYS is Committed to Pursuing Equity

Until now, AXYS has not explicitly stated our stance on the Black Lives Matter movement. AXYS acknowledges the disparity in diagnosis, treatment, and support of people of color. Instead of just a display of solidarity, we wanted to share with you our goals and future actions to work towards equity for people of color within the AXYS community.

Recently, AXYS held our first Families of Color call. The fundamental message, as said by Dalene Basden, is that people and families of color need AXYS to say “we are listening, and we are here to support you.”

After thought and discussion, and with direct input from the participants on the Families of Color call, AXYS has the following goals:

  • To support people of color in receiving equitable healthcare, education, and social support
  • To integrate information on the impact of systemic racism in the healthcare system into our CME courses
  • To better connect people with similar ethnic and cultural backgrounds for support within our community
  • To increase accessibility to research opportunities for people and families of color
  • To increase diversity of location for future in-person meetings

To achieve these goals, we will be taking the following steps:

  • Shifting the focus of our next ACRC meetings to discuss how each of our clinics can support equity
  • Modifying our “Stay Connected” form to include requests for demographic information including race and gender expression
  • Encouraging researchers to report information based on race so that families can take more specific information to their medical providers
  • Going through our professional directory to identify providers of color
  • Creating research-based additions to our CME courses
  • Continuing our conversations with people and families of color to reflect on AXYS’s past, present, and future actions

As individuals, as a community, and as a country, there is so much work that needs to be done to bridge the gap between the ideals of our society, and the realities for people of color. Another statement during the phone call that resonated with me was: “I have the power to make things happen.” I know I can count on the AXYS community to not only know that we can do better, but to take action.

-Erin Frith, AXYS Chair

2020-10-13T12:27:53-04:00Categories: All Variations|

Counseling in Pediatric Populations at Risk for Infertility and/or Sexual Function Concerns

Article Title: Counseling in Pediatric Populations at Risk for Infertility and/or Sexual Function Concerns

Authors: Nahata, Quinn, and Tishelman

Date of Publication: July 30, 2018

“Health care providers and parents report challenges in knowing how and when to discuss these issues. In this context, the goal of this clinical report is to review evidence and considerations for providers related to information sharing about impaired fertility and sexual function in pediatric patients attributable to congenital and acquired conditions or treatments.”

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2020-10-09T12:25:06-04:00Categories: 47,XXY (Klinefelter), 48,XXYY, Other Variations, XXXY|

European Academy of Andrology Guidelines on Klinefelter Syndrome

Article Title: European Academy of Andrology (EAA) Guidelines on Klinefelter Syndrome

Authors: Zitzmann, Aksglaede, Corona, Isidori, Juul, T’Sjoen, Kliesch, D’Hauwers, Toppari, Słowikowska-Hilczer, Tüttelmann, and Ferlin

Date of Publication: September 22, 2020

“These guidelines provide recommendations and suggestions to care for patients with KS in various developmental stages ranging from childhood and adolescence to adulthood. This advice is based on recent research data and respective evaluations as well as validations performed by a group of experts.”

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2020-09-29T11:08:05-04:00Categories: 47,XXY (Klinefelter)|
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