A Rock1, F Marcelli2, G Robin3, V Mitchell4, C Leroy5, J-M Rigot2. 1. Service d'andrologie, hôpital Albert-Calmette, CHRU de Lille, boulevard du Professeur-Jules-Leclercq, 59037 Lille cedex, France; Département d'urologie, hôpital Saint-Philibert, GHICL, 115, rue du Grand-But, BP 249, 59462 Lomme cedex, France. Electronic address: rock.aurelien@ghicl.net. 2. Service d'andrologie, hôpital Albert-Calmette, CHRU de Lille, boulevard du Professeur-Jules-Leclercq, 59037 Lille cedex, France. 3. Service d'andrologie, hôpital Albert-Calmette, CHRU de Lille, boulevard du Professeur-Jules-Leclercq, 59037 Lille cedex, France; Service de médecine de la reproduction, hôpital Jeanne-de-Flandres, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France. 4. Laboratoire de spermiologie, hôpital Albert-Calmette, CHRU de Lille, boulevard du Professeur-Jules-Leclercq, 59000 Lille cedex, France. 5. Service d'andrologie, hôpital Albert-Calmette, CHRU de Lille, boulevard du Professeur-Jules-Leclercq, 59037 Lille cedex, France; Service d'endocrinologie, hôpital Huriez, CHRU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France.
Abstract
PURPOSE: To attract urologists' attention on screening of Klinefelter syndrome consulting for infertility, describing its usual phenotype, in order to propose a possible reproductive technique, to prevent and to treat associated comorbidities and to manage the frequent discovery of ultrasonographic testicular lesions. PATIENTS AND METHODS: Retrospective analysis over 10 years of clinical and paraclinical features of the patients who consulted for infertility and had a 47,XX7 regular or mosaic karyotype. RESULTS: One hundred and forty-nine patients, 31.7 year-old on average [20.7-42.7], all had a severe bilateral testicular hypotrophy, subsequently confirmed by ultrasonography (mean total testicular volume: 3.7 mL [-0.20-7.64]). One hundred and twenty-two (81.9%) had normal secondary sexual characteristics, only 4 of them (2.7%) already knew their diagnosis. Their mean total testosterone levels were low (3.12 ng/mL [0.39-5.86]) but remain normal. A total of 34.2% of patients had subclinical testicular nodules discovered by ultrasonography. Excision was performed in 12 cases, confirming Leydig cell tumors. CONCLUSION: Klinefelter syndrome diagnosis can be made during a first consultation with a bilateral testicular hypotrophy as "pathognomonic" point of call in an often poor clinical observation. It is completed by an azoospermia or severe oligozoospermia. If they want to, this allows to quickly guide patients to suitable medical reproductive technique but, especially, to prevent and quickly treat comorbidities associated to this diagnosis, and also to reassure patients about the frequent discovery of subclinical testicular lesions.
PURPOSE: To attract urologists' attention on screening of Klinefelter syndrome consulting for infertility, describing its usual phenotype, in order to propose a possible reproductive technique, to prevent and to treat associated comorbidities and to manage the frequent discovery of ultrasonographic testicular lesions. PATIENTS AND METHODS: Retrospective analysis over 10 years of clinical and paraclinical features of the patients who consulted for infertility and had a 47,XX7 regular or mosaic karyotype. RESULTS: One hundred and forty-nine patients, 31.7 year-old on average [20.7-42.7], all had a severe bilateral testicular hypotrophy, subsequently confirmed by ultrasonography (mean total testicular volume: 3.7 mL [-0.20-7.64]). One hundred and twenty-two (81.9%) had normal secondary sexual characteristics, only 4 of them (2.7%) already knew their diagnosis. Their mean total testosterone levels were low (3.12 ng/mL [0.39-5.86]) but remain normal. A total of 34.2% of patients had subclinical testicular nodules discovered by ultrasonography. Excision was performed in 12 cases, confirming Leydig cell tumors. CONCLUSION:Klinefelter syndrome diagnosis can be made during a first consultation with a bilateral testicular hypotrophy as "pathognomonic" point of call in an often poor clinical observation. It is completed by an azoospermia or severe oligozoospermia. If they want to, this allows to quickly guide patients to suitable medical reproductive technique but, especially, to prevent and quickly treat comorbidities associated to this diagnosis, and also to reassure patients about the frequent discovery of subclinical testicular lesions.
Keywords:
Anomalie des chromosomes sexuels; Azoospermia; Azoospermie; Hypogonadism and testicular atrophy; Hypogonadisme et atrophie testiculaire; Infertility; Infertilité masculine; Klinefelter syndrome; Leydig cell tumor; Male; Sex chromosome aberrations; Syndrome de Klinefelter; Tumeurs à cellules de Leydig
Authors: Laurence Rocher; Parvati Ramchandani; Jane Belfield; Michele Bertolotto; Lorenzo E Derchi; Jean Michel Correas; Raymond Oyen; Athina C Tsili; Ahmet Tuncay Turgut; Vikram Dogra; Karim Fizazi; Simon Freeman; Jonathan Richenberg Journal: Eur Radiol Date: 2015-10-24 Impact factor: 5.315