A 47, XXY female

Abstract

Klinefelter syndrome (47,XXY) with male phenotype is the most common sex chromosomal abnormality. It is believed that SRY (sex determining region on Y) is the major gene necessary to induce the undifferentiated bipotential gonadal primordium to develop as testis. Recently, several SRY-boxrelated (SOX) genes have been identified on autosomes. Mutations in the SRY or SOX gene have been implicated in sex reversal. We report an individual having 47,XXY chromosome constitution, normal SRY, SOX9, and ZFY genes and yet with a female phenotype. A 15-year-old phenotypic female has well developed breasts; prominent labioscrotal folds; an enlarged clitoris; feminine pubic hair distribution; urethra in the centre of the vestibule; a urogenital sinus 5 cm deep; a uterus; prepubertal in shape and size, palpable per rectum; and a cervix which could not be palpated. Ultrasonography of the abdomen revealed normal shape of urinary bladder with smooth and regular walls. Uterus was small in size, with normal shape and outline. Myometrium was homologous, cavity was empty, midline echo was normal. Laparoscopic assessment revealed a normal uterus. Right ovary was normal in size and shape with a cyst and a normal Fallopian tube. Left ovary was not seen as it was hidden beneath an epithelial fold. Chromosome analysis showed 47,XXY karyotype in all 100 metaphases analysed. Hormone profiles showed average female range of corticotrophin, T3, T4, thyrotrophin, and testosterone. Progesterone and prolactin were higher when compared with normal female levels. Histology of the right gonad showed features compatible with ovarian stroma. No RESEARCH LETTERS