49,XXXXY syndrome is an extremely rare
aneuploidicsex chromosomal abnormality. It occurs in approximately 1 out of 85,000 to 100,000 males.[1][2][3] This syndrome is the result of maternal
non-disjunction during both
meiosis I and
II.[4] It was first diagnosed in 1960 and was coined Fraccaro syndrome after the researcher.[2]
Signs and symptoms
The symptoms of 49,XXXXY are slightly similar to those of
Klinefelter syndrome and
48,XXXY, but they are usually much more severe.
Aneuploidy is often fatal, but there is "
X-inactivation", where the effect of the additional gene dosage due to the presence of extra X chromosomes is greatly reduced.[5]
Reproductive
Those with 49,XXXXY syndrome tend to exhibit infantile secondary sex characteristics with sterility in adulthood.[5]
Much like
Down syndrome, the mental effects of 49,XXXXY syndrome vary. Impaired speech and maladaptive behavioral problems are typical.[9] One study looked at males that were diagnosed with
48,XXYY,
48,XXXY and 49,XXXXY. They found that males with 48,XXXY and 49,XXXXY function at a much lower cognitive level than males their age. These males also tend to exhibit more immature behavior for their chronological age; increased aggressive tendencies were also cited in this study.[9]
A 2020 study found that boys with 49,XXXXY have heightened rates of internalizing behavior and anxiety, beginning as early as preschool.[10] Tests using the
Social Responsiveness Scale-2 (SRS-2) found that while those with the condition generally showed more signs of social impairment, there was minimal effect on their social awareness.[10]
Pathophysiology
As its name indicates, a person with the syndrome has one
Y chromosome and four
X chromosomes on the 23rd pair, thus having forty-nine chromosomes rather than the normal forty-six. As with most categories of
aneuploidy disorders, 49,XXXXY syndrome is often accompanied by
intellectual disability. It can be considered a form or variant of
Klinefelter syndrome (47,XXY).[11] Individuals with this syndrome are typically
mosaic, being 49,XXXXY/48, XXXX.[4]
It is genetic but not hereditary, meaning that while the genes of the parents cause the syndrome, there is a small chance of more than one child having the syndrome. The probability of inheriting the disease is about one percent.[5]
While there is no treatment to correct the genetic abnormality of this syndrome, there is the potential to treat the symptoms. As a result of infertility, one man from Iran used artificial reproductive methods.[4] An infant in Iran diagnosed with 49,XXXXY syndrome was born with
patent ductus arteriosus, which was corrected with surgery, and other complications that were managed with replacement therapy.[4]
The administration of testosterone therapy has been shown to improve motor skills, speech, and nonverbal IQ in males with 49,XXXXY.[13]
^
abcdeHadipour, Fatemeh; Shafeghati, Yousef; Bagherizadeh, Eiman; Behjati, Farkhondeh; Hadipour, Zahra (2013). "Fraccaro syndrome: report of two Iranian cases: an infant and an adult in a family". Acta Medica Iranica. 51 (12): 907–909.
ISSN1735-9694.
PMID24442548.
^Sprouse, Courtney; Tosi, Laura; Stapleton, Emily; Gropman, Andrea L.; Mitchell, Francie L.; Peret, Rick; Sadeghin, Teresa; Haskell, Kathryn; Samango-Sprouse, Carole A. (2013). "Musculoskeletal anomalies in a large cohort of boys with 49, XXXXY". American Journal of Medical Genetics. 163 (1): 44–49.
doi:
10.1002/ajmg.c.31354.
PMID23359596.
S2CID40989726.
^
abVisootsak J, Rosner B, Dykens E, Tartaglia N, Graham JM (June 2007). "Behavioral phenotype of sex chromosome aneuploidies: 48,XXYY, 48,XXXY, and 49,XXXXY". Am. J. Med. Genet. A. 143A (11): 1198–203.
doi:
10.1002/ajmg.a.31746.
PMID17497714.
S2CID25732790.
^
abLasutschinkow, Patricia C.; Gropman, Andrea L.; Porter, Grace F.; Sadeghin, Teresa; Samango-Sprouse, Carole A. (2020-02-21). "Behavioral phenotype of 49,XXXXY syndrome: Presence of anxiety-related symptoms and intact social awareness". American Journal of Medical Genetics. 182 (5): 974–986.
doi:
10.1002/ajmg.a.61507.
PMID32083381.
S2CID211230717 – via Wiley Online Database.
^Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis, Mo: Elsevier Saunders. p. 179.
ISBN0-7216-0187-1.