• 생물정신의학
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• 제2권2호
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• pp.287-294
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• 1995

A male patient with subnormal intelligence and schizoaffective symptoms was confirmed to have Klinefelter's syndrome with the karyotype of 47,XXY by the chromosomal analysis. He was shown to have a peculiar appearance of tall height, long extremities, gynecomastia and small ears. The hormonal study revealed decreased testosterone and increased FSH concentrations in the serum of the patient. He was also found to have small testes by the ultrasonography, which seemed to be sterile by the semen analysis. We reported this rare case and reviewed related articles.

• Clinical and Experimental Pediatrics
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• 제48권12호
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• pp.1317-1323
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• 2005

목 적 : 성염색체이상증후군은 사춘기 이후 이차 성징의 결여로 그 증상이 뚜렷해지므로 사춘기 이전의 진단은 쉽지 않다. 본 연구는 성염색체이상증후군의 빈도, 진단시 연령, 그리고 임상적 특징을 조사하여 그 의의를 알아보고자 한다. 방 법 : 1981년 2월부터 2001년 8월까지 20년 동안 경북대학교병원 소아과 염색체검사실에 의뢰된 염색체검사 중 성염색체 이상증후군으로 진단된 115례 환자의 임상적 특징, 진단시 연령 그리고 핵형 분석을 후향적인 방법으로 조사하였다. 결 과 : 성염색체이상증후군의 종류와 빈도는 Klinefelter 증후군은 52%, Turner 증후군은 42%, XXX 증후군은 3%, 혼합 성선이형성은 3%였다. Klinefelter 증후군은 47,XXY가 97%, mosaicism이 3%였고, Turner 증후군은 45,X가 67%, mosaicism이 23%, X 염색체의 구조적 이상은 10%였다. XXX 증후군은 47,XXX가 67%, mosaicism은 33%였고, 혼합 성선이형성은 모두 45,X/46,XY였다. 성염색체이상증후군의 81%가 사춘기 이후에 진단되었다. 신생아기에 Klinefelter 증후군과 Turner 증후군으로 진단받은 경우는 표현형이 정상이거나 경한 선천성기형만을 보였다. Turner 증후군과 Klinefelter 증후군의 mosaicism이나 구조적 이상군에서 전형적인 45,X나 47,XXY보다 신체상 증상 발현이 경미할 것으로 생각되었으나 본 연구에서는 통계학적으로 유의한 차이는 보이지 않았다. 결 론 : 성염색체이상증후군은 사춘기 이전에는 그 증상이 뚜렷하지 않으므로 환아에 대한 주의 깊은 관찰과 관심으로 조기에 진단하여 정상적인 정신성적발달과 성장발육 및 성생활을 유지하도록 부모와 환아의 질환에 대한 인지도를 높여야 할 것으로 사료된다. 특히 핵형 분석시 Turner 증후군은 X염색체의 다양한 구조 이상 또는 mosaicism의 빈도가 높기 때문에 핵형 분석시 이를 염두에 두어야 한다.

• Clinical and Experimental Reproductive Medicine
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• 제31권4호
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• pp.253-260
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• 2004

Objectives: Klinefelter syndrome is the most common genetic cause of male infertility and presents with 47, XXY mainly or 46, XX/47, XXY mosaicism. It is characterized by hypogonadism and azoospermia due to testicular failure, however, sporadic cases of natural pregnancies have been reported. With the development of testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI), sperm can be retrieved successfully and ART is applied in these patients for pregnancy. It has been suggested that the risk of chromosome aneuploidy for both sex chromosome and autosome is increased in the sperms from 47, XXY germ cells. Considering the risk for chromosomal aneuploidy in the offspring, preimplantation genetic diagnosis (PGD) could be applied as a safe and more effective treatment option in Klinefelter syndrome. The aim of this study is to assess the outcome of PGD cycles by using FISH for sex chromosome and autosome in patients with Klinefelter syndrome. Materials and Methods: From Jan. 2001 to Dec. 2003, PGD was attempted in 8 cases of Klinefelter syndrome but TESE was failed to retrieve sperm in the 3 cases, therefore PGD was performed in 8 cycles of 5 cases (four 47, XXY and one 46, XY/47, XXY mosaicism). In one case, ejaculated sperm was used and in 4 cases, TESE sperm was used for ICSI. After fertilization, blastomere biopsy was performed in $6{\sim}7$ cell stage embryo and the chromosome aneuploidy was diagnosed by using FISH with CEP probes for chromosome X, Y and 17 or 18. Results: A total of 127 oocytes were retrieved and ICSI was performed in 113 mature oocytes. The fertilization rate was $65.3{\pm}6.0%$ (mean$\pm$SEM) and 76 embryos were obtained. Blastomere biopsy was performed in 61 developing embryos and FISH analysis was successful in 95.1% of the biopsied blastomeres (58/61). The rate of balanced embryos for chromosome X, Y and 17 or 18 was $39.7{\pm}6.9%$. The rate of aneuploidy for sex chromosome (X and Y) was $45.9{\pm}5.3%$ and $43.2{\pm}5.8%$ for chromosome 17 or 18, respectively. Embryo transfer was performed in all 8 cycles and mean number of transferred embryos was $2.5{\pm}0.5$. In 2 cases, clinical pregnancies were obtained and normal 46, XX and 46, XY karyotypes were confirmed by amniocentesis, respectively. Healthy male and female babies were delivered uneventfully at term. Conclusion: The patients with Klinefelter syndrome can benefit from ART with TESE and ICSI. Considering the risk of aneuploidy for both sex chromosome and autosome in the sperms and embryos of Klinefelter syndrome, PGD could be offered as safe and more effective treatment option.

• 생명과학회지
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• 제17권6호통권86호
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• pp.741-747
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• 2007

무정자증 환자의 경우, 정확히 알려지지 않은 유전적인 요인들이 남성불임과 연관되어 있다. 그들 중 클라인펠트 증후군(KS)과 정상 핵형의 남성에게서 발견되는 Y염색체상의 미세결실 증상(YMNK)은 남성 불임의 가장 빈번한 원인이라고 할 수 있다. 본 연구는 한국인 집단에서 남성불임으로 고통 받고 있는 YMNK (66 개체)와 KS(30 개체) 환자들을 비교 분석 하였다. Y염색체 상의 AZFa,b,c 영역의 미세결실을 분석하기 위해 19개의 STS 프라이머를 이용해 PCR분석을 하였다. 실험 결과 YMNK의 34.9%와 KS의 73.4%가 미세결실을 포함하고 있었다. 이점으로 미루어보아 YMNK환자보다 KS환자의 경우가 Y염색체의 불안정성이 더욱 높은 것으로 사료된다. 결론적으로 미세결실을 포함하는 제놈의 불안정성은 정상적인 정자형성 과정을 방해하여 남성불임을 초래할 수 있을 것이다.

• Journal of Interdisciplinary Genomics
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• 제4권2호
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• pp.24-30
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• 2022

Klinefelter's syndrome (KS) is a syndrome with extra X chromosome(s), in XY individuals, characterized by gynecomastia, small testes, and infertility. Additional X chromosomes can be present as variable karyotypic forms, including mosaicism (47,XXY/46,XY). The reported prevalence of KS ranges from one in 500 to one in 1,000 live males, but is probably underestimated. The classic phenotype is small, firm testes and infertility resulting from seminiferous tubule dysgenesis and androgen deficiency. The spectrum of KS includes tall stature with relatively long legs and arm span, decreased body hair, learning disabilities, behavioral problems, poor motor skills, and other important medical issues, such as metabolic syndrome, diabetes, autoimmune diseases, cardiovascular disease, certain neoplasia. The increased risk of certain medical problems in KS can be attributed to a direct effect of the extra X chromosome, the combined action of multiple genomic and epigenetic factors, or the hormonal imbalances. Typically, chromosome analysis is not ordered for adult patients with general medical conditions, except for suspected cases of hematologic and lymphoid disorders. Even though it was found during work-up for certain disorders in adult patient, most physicians do not suspect KS or consider its impact. Therefore, understanding the pathophysiology and variable manifestation in KS is necessary, and discussions with multidisciplinary teams will help to diagnose and treat males with KS.

• Clinical and Experimental Pediatrics
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• 제45권9호
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• pp.1141-1145
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• 2002

Klinefelter 증후군에서는 여러 가지 선천성 기형을 동반하지만 신장의 기형은 드믄 편이며 현재까지 49, XXXXY 증후군에서 다낭성 신이 동반된 경우가 있었고, 47, XXY 증후군에서는 편측성 신 형성부전이 동반된 경우가 보고되었으나 다낭성신 이형성의 보고는 없었다. 따라서 저자들은 신생아기에 발견된 편측 다낭성 신이형성이 동반된 Klinefelter 증후군 1례를 경험하였기에 보고하는 바이다.

• Clinical and Experimental Reproductive Medicine
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• 제9권1_2호
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• pp.79-93
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• 1982

We collected a total of 109 patients with intersex during the past 16 years (1966-1982). They were summerized as follows: Klinefelter's syndrome, the most common disease, was found in 76 cases, Turner's syndrome in 3 cases, true hermaphroditism in 5 cases, male pseudohermaphroditism in 5 cases, female pseudohermaphroditism in 13 cases and others in 7 cases in which 2 cases of XX male syndrome, 1 case of agonadism, 1 case of hernia uteri inguinale and 3 cases of unclassified intersex were included. 2 mosaic Klinefelter's syndrome showed 46/47 XX/XXY and 1 mosaic Turner's syndrome showed 45/46 XO/XX. The 5 patients with true hermaphroditism included 2 cases that had an ovary on one side and a testis on the other, 1 case, seperate ovary and testis on each side, 1 case, an ovary on one side and a seperate testis and ovary on the other and 1 case, an ovary on one side and an ovotestis on the other. Sex chromosome study on the true hermaphroditism revealed 46 XX in 2 patients and 46/46 XX/XY mosaicism in 3 patients. In male pseudohermaphroditism, all patients had a short and blind vagina. Of which, familial tendency was found in 1 case. Her sister had operation for sex reversal for female. In female psedohermaphroditism, all the patients were adrenogenital syndrome. Operations for clitoridectomy and vaginoplasty were performed on 10 patients. Hydrocortisone was given to 6 patients. Menstruation started to occur 6 months and 4 months after the medical therapy respectively in 2 cases.

• Tuberculosis and Respiratory Diseases
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• 제43권6호
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• pp.1035-1041
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• 1996

저자등은 Klinefelter 증후군에 병발된 원발성 종격동 혼합형 생식세포종(mixded germ cell tumor)을 가진 환자 1예를 경험하였기에 이에 문헌고찰과 함께 보고하는 바이다.

• Clinical and Experimental Reproductive Medicine
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• 제26권1호
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• pp.43-54
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• 1999

Klinefelter's syndrome is a very important disease in gynecologic endocrinologic fields, because the patients with this karyotype complain of infertility, azospermia and ambiguous genitalia. Y chromosome is an important chromosome which determine genetic sex and the structure of gonad and genitalia. In this study, to elucidate the cytogenetic characteristics and clinical features of Klinefelter's syndrome and Y chromosomal abnormalities in Korea, we studied 303 cases of Klinefelter's syndrome and 11 cases of Y chromosomal abnormalities which were diagnosed by chromosomal analysis at the Cytogenetic Laboratory, Institute of Reproductive Medicine and Population, Seoul National University for 12 years from January 1984 to December 1996. The results of this study showed as follows: 1. In a total of 9275 cases, there were 303 cases (3.3%) of Klinefelter's syndromes, 11 cases (0.1%) of Y chromosomal abnormalities. 2. In 102 cases of patients showed typical clinical features of Klinefelter's syndrome, 101 cases (99%) of them were diagnosed to Klinefelter's syndrome in karyotyping. 3. In 303 cases of Klinefelter's syndrome, there were 277 cases (91.4%) of 47,XXY complement, 16 cases (5.3%) of mosaicism, 2 cases (0.7%) of 48,XXXY, 5 cases (1.7%) of 48,XXYY and 3 cases (1.0%) of 49,XXXXY. 4. In 303 cases of Klinefelter's syndrome, 284 cases (93.7%) of them were diagnosed after puberty and only 19 cases (6.3%) of them were diagnosed before puberty. 5. In 303 cases of Klinefelter's syndrome, there were 146 cases (48.2%) of patients with infertility-associated chief complaints, 101 cases (33.3%) of patients with typical clinical features of Klinefelter's syndrome, 22 cases (7.3%) of patients with ambiguous genitalia. 6. In patients with Klinefelter's syndrome, 48,XXYY and 49,XXXXY had serious symptoms such as mental retardation, developmental delay, Down syndrome-like features, congenital anomalies, but 48,XXYY and other mosaicisms had infertility-associated symptoms or ambiguous genitalia. 7. The 8 cases of polysomy Y (XYY complement) showed several serious symptoms such as Down syndrome-like features, mental retardation, fragile X syndrome-like feature, congenital anomalies, ambiguous genitalia which could be detected before puberty.

• Clinical and Experimental Pediatrics
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• 제45권3호
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• pp.311-319
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• 2002

1974년 3월부터 1998년 8월까지 약 25년간 본 소아과에서 염색체 분석을 시행하였던 환아 중 염색체 이상증후군을 의심할 만한 임상증상을 가졌던 756례와 반음양, 경미한 성적 이상, 다발성 기형, 지능저하 및 성장장애 등이 있었던 424례의 결과를 종합한 총 1,180례의 결과를 비교 검토하였다. 1) 상염색체이상증후군의 남녀 비는 1.2 : 1이었다. 대상군의 연령분포는 상염색체이상군에서 1세 미만이 78.6%로 많았고, 성염색체이상군에서는 12세 이상이 89.8%로 많았다. 2) 전체 1180례 중 612례에서 염색체 이상을 보여 양성율이 51.9%였다. 그 중 상염색체이상증후군을 의심한 군의 경우는 597례 중 497례(83.2%)에서, 성염 색체이상을 의심한 군은 159례 중 93례(58.5%)에서, 기타 반음양, 경미한 성적 이상, 다발성 선천성 기형, 지능저하 및 성장장애에서는 424례 중 22례(5.2%)에서 이상소견을 보였다. 상염색체이상증후군 중 Down 증후군은 88.8%, E군 이상은 50%, D군 이상은 53.6%, 묘성 증후군은 71.4%의 양성율을 보였다. 성염색체이상증후군은 Turner 증후군은 63.3%, Klinefelter 증후군은 51.6%, Fragile X 증후군은 33.3%의 양성율을 보였다. 3) 염색체 이상의 핵형별 분포는 상염색체 이상이 514례로 83.8%, 성염색체 이상이 98례로 16.2%이었다. 성염색체 이상 중 Down 증후군이 86.8%로 가장 많았고 다음은 E군, D군, B군, A군, C군 이상 순이었다. 성염색체 이상은 Turner 증후군, Klinefelter 증후군, Fragile X 증후군이었다. 4) 가장 많았던 Down 증후군의 핵형별 빈도는 21 삼체성이 88.5%, 전좌형이 9.7%, mosaicism이 1.8%였다. 27례의 E군 이상 중 Edwards 증후군은 12례, 18p 단체성은 8례, 기타가 7례 였다. 15례의 D군 이상 중 Patau 증후군은 9례, 기타가 6례였다. 5) Turner 증후군은 57례 중 45,X가 19례로 33.3%였고 이형은 38례로 66.7%였다. Klinefelter 증후군은 32례 모두 47,XXY의 핵형이었다.