Clinical but Not Histological Outcomes in Males with 45,X/46,XY Mosaicism Vary Depending on Reason for Diagnosis

Marie Lindhardt Ljubicic, Anne Jørgensen, Carlo Acerini, Juliana Andrade, Antonio Balsamo, Silvano Bertelloni, Martine Cools, Rieko Tadokoro Cuccaro, Feyza Darendeliler, Christa E. Flück, Romina P. Grinspon, Andrea MacIel-Guerra, Tulay Guran, Sabine E. Hannema, Angela K. Lucas-Herald, Olaf Hiort, Paul Martin Holterhus, Corina Lichiardopol, Leendert H.J. Looijenga, Rita OrtolanoStefan Riedl, S. Faisal Ahmed, Anders Juul

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22 Citations (Scopus)

Abstract

Context: Larger studies on outcomes in males with 45,X/46,XY mosaicism are rare. Objective: To compare health outcomes in males with 45,X/46,XY diagnosed as a result of either genital abnormalities at birth or nongenital reasons later in life. Design: A retrospective, multicenter study. Setting: Sixteen tertiary centers. Patients or Other Participants: Sixty-three males older than 13 years with 45,X/46,XY mosaicism. Main Outcome Measures: Health outcomes, such as genital phenotype, gonadal function, growth, comorbidities, fertility, and gonadal histology, including risk of neoplasia. Results: Thirty-five patients were in the genital group and 28 in the nongenital. Eighty percent of all patients experienced spontaneous pubertal onset, significantly more in the nongenital group (P = 0.023). Patients were significantly shorter in the genital group with median adult heights of 156.7 cm and 164.5 cm, respectively (P = 0.016). Twenty-seven percent of patients received recombinant human GH. Forty-four patients had gonadal histology evaluated. Germ cells were detected in 42%. Neoplasia in situ was found in five patients. Twenty-five percent had focal spermatogenesis, and another 25.0% had arrested spermatogenesis. Fourteen out of 17 (82%) with semen analyses were azoospermic; three had motile sperm. Conclusion: Patients diagnosed as a result of genital abnormalities have poorer health outcomes than those diagnosed as a result of nongenital reasons. Most patients, however, have relatively good endocrine gonadal function, but most are also short statured. Patients have a risk of gonadal neoplasia, and most are azoospermic, but almost one-half of patients has germ cells present histologically and up to one-quarter has focal spermatogenesis, providing hope for fertility treatment options.

Original languageEnglish
Pages (from-to)4366-4381
Number of pages16
JournalJournal of clinical endocrinology and metabolism
Volume104
Issue number10
DOIs
Publication statusPublished - 1 Oct 2019

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