Triple X syndrome

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Triple X syndrome
Other namesTriplo-X syndrome, trisomy X, XXX syndrome, 47,XXX syndrome [1]
XXXSyndromeB.png
Increased distance between the eyes in a 9-year-old girl with trisomy X [2]
Specialty Medical genetics
SymptomsTaller than average [1]
Complications Learning difficulties, decreased muscle tone, seizures, kidney problems [1]
CausesRandom event [1]
Diagnostic method Chromosomal analysis [3]
TreatmentSpeech therapy, physical therapy, counseling [3]
Frequency1 per 1,000 female births [2]

Triple X syndrome, also known as trisomy X and 47,XXX, is characterized by the presence of an extra X chromosome in each cell of a female. [1] Those affected are often taller than average. [1] Usually there are no other physical differences and normal fertility. [1] Occasionally there are learning difficulties, decreased muscle tone, seizures, or kidney problems. [1]

Contents

Triple X is due to a random event. [1] Triple X can result either during the division of the mother's reproductive cells or during division of cells during early development. [2] It is not typically inherited from one generation to the next. [1] A form where only a percentage of the body cells contain XXX can also occur. [1] Diagnosis is by chromosomal analysis. [3]

Treatment may include speech therapy, physical therapy, and counseling. [3] It occurs in about one in every 1,000 female births. [2] It is estimated that 90% of those affected are not diagnosed as they either have no or only few symptoms. [2] It was first identified in 1959. [4]

Signs and symptoms

Because the vast majority of triple X females are never diagnosed, it may be very difficult to make generalizations about the effects of this syndrome. The samples that were studied were small and may be nonrepresentative. Because of the lyonization, inactivation, and formation of Barr bodies in all female cells, only one X chromosome is active at any time. A person with triple X syndrome will have two Barr bodies in each cell, leading to most persons having only mild effects or no effects. The symptoms vary from person to person, with some people being more affected than others.

Physical

Symptoms may include tall stature, vertical skin folds that may cover the inner corners of the eyes (epicanthal folds), poor muscle tone, and a curve in the 5th finger towards the 4th (clinodactyly). [2] There may also be a small head (microcephaly). [5] There are seldom any observable physical anomalies in triple X females, other than being taller than average.

Poor coordination may be present. [6] Those affected appear to have higher rates of scoliosis. [6]

Psychological

Females with triple X syndrome often have delayed language development. [6] On average those affected have IQs that are 20 points lower. [6] Poor self-esteem, anxiety, and depression are also common, [2] [6] as are autistic features. [7]

Cause

Problems in male meiosis resulting in a male gamete with 2 X-chromosomes. XXX syndrome (male).svg
Problems in male meiosis resulting in a male gamete with 2 X-chromosomes.
Problems in female meiosis resulting in a female gamete with 2 X-chromosomes. XXX syndrome (female).svg
Problems in female meiosis resulting in a female gamete with 2 X-chromosomes.

Triple X syndrome is not inherited, but usually occurs as an event during the formation of reproductive cells (ovum and sperm). An error in cell division called nondisjunction can result in reproductive cells with additional chromosomes. For example, an oocyte or sperm cell may gain an extra copy of the X chromosome as a result of the non-disjunction. If one of these cells contributes to the genetic makeup of a child, the child will have an extra X chromosome in each of her cells. In some cases, trisomy X occurs during cell division in early embryonic development.

Some females with triple X syndrome have an extra X chromosome in only some of their cells. These cases are called 46,XX/47,XXX mosaics.

Diagnosis

The vast majority of triple X women are never diagnosed, unless they undergo tests for other medical reasons later in life. Triple X can be diagnosed by a blood test which is able to look at a person’s chromosomes (karyotype). Abnormalities on the electroencephalography may be present. [6]

Triple X syndrome can be diagnosed prenatally through amniocentesis or chorionic villus sampling. In Denmark, between 1970 and 1984, 76% of the prenatally diagnosed fetuses with triple-X were aborted. By 1987, this figure dropped to 56%. With improved information, the number of abortions diminished. In the Netherlands, between 1991 and 2000, 33% (18/54) of the couples that were confronted with a prenatal diagnosis of 47, XXX elected to abort. If balanced information is provided to prospective parents, prenatally, the incidence of voluntary termination (abortion) is reduced. [8]

Treatment

A stable home environment can improve some of the symptoms. [6]

Epidemiology

Triple X syndrome occurs in around 1 in 1,000 girls. On average, five to ten girls with triple X syndrome are born in the United States each day. [9]

History

The first published report of a woman with a 47,XXX karyotype was by Patricia A. Jacobs, et al. at Western General Hospital in Edinburgh, Scotland, in 1959. It was found in a 35‑year-old, 5 ft. 9 in. (176 cm) tall, 128 lb. (58.2 kg) woman who had premature ovarian failure at age 19; her mother was age 41 and her father was 40 at the time of her conception. [10] Jacobs, et al. called the 47,XXX woman a "superfemale", a term which was immediately criticized, did not gain acceptance, and was based on the incorrect assumption that the sex-determination system in mammals was the same as in the fruit fly Drosophila . [11] British pathologist and geneticist Bernard Lennox, the principal consultant on medical terms for the Oxford English Dictionary , suggested the term "XXX syndrome". [12]

Related Research Articles

Down syndrome Genetic disorder, also known as "trisomy 21"

Down syndrome or Down's syndrome, also known as trisomy 21, is a genetic disorder caused by the presence of all or part of a third copy of chromosome 21. It is usually associated with physical growth delays, mild to moderate intellectual disability, and characteristic facial features. The average IQ of a young adult with Down syndrome is 50, equivalent to the mental ability of an eight- or nine-year-old child, but this can vary widely.

Genetic disorder Health problem caused by one or more abnormalities in the genome

A genetic disorder is a health problem caused by one or more abnormalities in the genome. It can be caused by a mutation in a single gene (monogenic) or multiple genes (polygenic) or by a chromosomal abnormality. Although polygenic disorders are the most common, the term is mostly used when discussing disorders with a single genetic cause, either in a gene or chromosome. The mutation responsible can occur spontaneously before embryonic development, or it can be inherited from two parents who are carriers of a faulty gene or from a parent with the disorder. When the genetic disorder is inherited from one or both parents, it is also classified as a hereditary disease. Some disorders are caused by a mutation on the X chromosome and have X-linked inheritance. Very few disorders are inherited on the Y chromosome or mitochondrial DNA.

XYY syndrome Genetic condition in which a male has an extra Y chromosome

XYY syndrome is a genetic condition in which a male has an extra Y chromosome. There are usually few symptoms. These may include being taller than average, acne, and an increased risk of learning problems. The person is generally otherwise typical, including typical rates of fertility.

Trisomy

A trisomy is a type of polysomy in which there are three instances of a particular chromosome, instead of the normal two. A trisomy is a type of aneuploidy.

Turner syndrome Chromosomal disorder in which a female is partly or completely missing an X chromosome

Turner syndrome (TS), also known 45,X, or 45,X0, is a genetic condition in which a female is partly or completely missing an X chromosome. Signs and symptoms vary among those affected. Often, a short and webbed neck, low-set ears, low hairline at the back of the neck, short stature, and swollen hands and feet are seen at birth. Typically, they develop menstrual periods and breasts only with hormone treatment, and are unable to have children without reproductive technology. Heart defects, diabetes, and low thyroid hormone occur more frequently. Most people with TS have normal intelligence, however many have troubles with spatial visualization that may be needed for mathematics. Vision and hearing problems occur more often.

Hirschsprungs disease

Hirschsprung's disease is a birth defect in which nerves are missing from parts of the intestine. The most prominent symptom is constipation. Other symptoms may include vomiting, abdominal pain, diarrhea and slow growth. Symptoms usually become apparent in the first two months of life. Complications may include enterocolitis, megacolon, bowel obstruction and intestinal perforation.

Patau syndrome Chromosomal disorder in which there are three copies of chromosome 13

Patau syndrome is a syndrome caused by a chromosomal abnormality, in which some or all of the cells of the body contain extra genetic material from chromosome 13. The extra genetic material disrupts normal development, causing multiple and complex organ defects.

Edwards syndrome Chromosomal disorder in which there are three copies of chromosome 18

Edwards syndrome, also known as trisomy 18, is a genetic disorder caused by the presence of a third copy of all or part of chromosome 18. Many parts of the body are affected. Babies are often born small and have heart defects. Other features include a small head, small jaw, clenched fists with overlapping fingers, and severe intellectual disability.

Nondisjunction

Nondisjunction is the failure of homologous chromosomes or sister chromatids to separate properly during cell division. There are three forms of nondisjunction: failure of a pair of homologous chromosomes to separate in meiosis I, failure of sister chromatids to separate during meiosis II, and failure of sister chromatids to separate during mitosis. Nondisjunction results in daughter cells with abnormal chromosome numbers (aneuploidy).

Prenatal testing consists of prenatal screening and prenatal diagnosis, which are aspects of prenatal care that focus on detecting problems with the pregnancy as early as possible. These may be anatomic and physiologic problems with the health of the zygote, embryo, or fetus, either before gestation even starts or as early in gestation as practicable. Screening can detect problems such as neural tube defects, chromosome abnormalities, and gene mutations that would lead to genetic disorders and birth defects, such as spina bifida, cleft palate, Downs Syndrome, Tay–Sachs disease, sickle cell anemia, thalassemia, cystic fibrosis, muscular dystrophy, and fragile X syndrome. Some tests are designed to discover problems which primarily affect the health of the mother, such as PAPP-A to detect pre-eclampsia or glucose tolerance tests to diagnose gestational diabetes. Screening can also detect anatomical defects such as hydrocephalus, anencephaly, heart defects, and amniotic band syndrome.

Kabuki syndrome

Kabuki syndrome is a congenital disorder of genetic origin. It affects multiple parts of the body, with varying symptoms and severity, although the most common is the characteristic facial appearance.

Pentasomy X

Pentasomy X, also known as 49,XXXXX, is a chromosomal abnormality in which a female has five X chromosomes instead of the normal two. Signs may include intellectual disability, short height, low-set ears, decreased muscle tone, and developmental delay. Complications may include congenital heart disease.

XXYY syndrome Extra X and Y chromosome in males

XXYY syndrome is a sex chromosome anomaly in which males have an extra X and Y chromosome. Human cells usually contain two sex chromosomes, one from the mother and one from the father. Usually, females have two X chromosomes (XX) and males have one X and one Y chromosome (XY). The appearance of at least one Y chromosome with a properly functioning SRY gene makes a male. Therefore, humans with XXYY are genotypically male. Males with XXYY syndrome have 48 chromosomes instead of the typical 46. This is why XXYY syndrome is sometimes written as 48,XXYY syndrome or 48,XXYY. It affects an estimated one in every 18,000–40,000 male births.

49,XXXXY syndrome is an extremely rare aneuploidic sex chromosomal abnormality. It occurs in approximately 1 out of 85,000 to 100,000 males. This syndrome is the result of maternal non-disjunction during both meiosis I and II. It was first diagnosed in 1960 and was coined Fraccaro syndrome after the researcher.

Patricia Ann Jacobs OBE FRSE FRS FMedSci FRCPath is a Scottish geneticist and is Honorary Professor of Human Genetics, Co-director of Research, Wessex Regional Genetics Laboratory, within the University of Southampton.

Klinefelter syndrome Human disease

Klinefelter syndrome (KS), also known as 47,XXY is the set of symptoms that result from two or more X chromosomes in males. The primary features are infertility and small poorly functioning testicles. Often, symptoms are subtle and subjects do not realize they are affected. Sometimes, symptoms are more evident and may include weaker muscles, greater height, poor motor coordination, less body hair, breast growth, and less interest in sex. Often it is only at puberty that these symptoms are noticed. Intelligence is usually normal; however, reading difficulties and problems with speech are more common. Symptoms are typically more severe if three or more X chromosomes are present.

The Focus Foundation, located in Davidsonville, Maryland, is a research foundation dedicated to identifying and assisting families and children who have X and Y Chromosomal Variations, dyslexia and/or developmental coordination disorder. These conditions can lead to language-based disabilities, motor planning deficits, reading dysfunction, and attention and behavioral disorders. The Focus Foundation believes that, through increased awareness, early identification, and specific and targeted treatment, children with these conditions can reach their full potential.

L1 syndrome

L1 syndrome is a group of mild to severe X-linked recessive disorders that share a common genetic basis. The spectrum of L1 syndrome disorders includes X-linked complicated corpus callosum agenesis, spastic paraplegia type 1, MASA syndrome, and X-linked hydrocephalus with stenosis of the aqueduct of Sylvius (HSAS). It is also called L1CAM syndrome and CRASH syndrome, an acronym for its primary clinical features: corpus callosum hypoplasia, retardation, adducted thumbs, spasticity, and hydrocephalus.

XYYY syndrome Chromosomal disorder

XYYY syndrome, also known as 48,XYYY, is a chromosomal disorder in which a male has two extra copies of the Y chromosome. The syndrome is exceptionally rare, with only twelve recorded cases. The phenotype of the syndrome is heterogeneous, but appears to be more severe than its counterpart XYY syndrome. Common traits include borderline to mild intellectual disability, infertility, radioulnar synostosis, and in some cases tall stature.

Tetrasomy X Chromosomal disorder with 4 X chromosomes

Tetrasomy X, also known as 48,XXXX, is a chromosomal disorder in which a female has four, rather than two, copies of the X chromosome. It is associated with intellectual disability of varying severity, characteristic facial features, heart defects, and skeletal anomalies. Tetrasomy X is a rare condition, with around 100 cases recognized in the medical literature; prevalence estimates are between 1 in 85,000 and 1 in 100,000.

References

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  2. 1 2 3 4 5 6 7 8 Tartaglia, NR; Howell, S; Sutherland, A; Wilson, R; Wilson, L (11 May 2010). "A review of trisomy X (47,XXX)". Orphanet Journal of Rare Diseases. 5: 8. doi:10.1186/1750-1172-5-8. PMC   2883963 . PMID   20459843.
  3. 1 2 3 4 "47 XXX syndrome". GARD. 16 March 2016. Archived from the original on 5 November 2016. Retrieved 26 September 2016.
  4. Wright, David (2011). Downs: The history of a disability. OUP Oxford. p. 159. ISBN   9780191619786. Archived from the original on 2017-09-11.
  5. "Triple X syndrome". Mayo Clinic. August 17, 2010. Archived from the original on 2012-02-28.
  6. 1 2 3 4 5 6 7 Otter, M; Schrander-Stumpel, CT; Curfs, LM (March 2010). "Triple X syndrome: a review of the literature". European Journal of Human Genetics. 18 (3): 265–71. doi:10.1038/ejhg.2009.109. PMC   2987225 . PMID   19568271.
  7. Otter M, Crins PML, Campforts BCM, Stumpel CTRM, van Amelsvoort T, Vingerhoets C (15 February 2021). "Social functioning and emotion recognition in adults with triple X syndrome". BJPsych Open. 7 (2). doi: 10.1192/bjo.2021.8 .
  8. Schrander-Stumpel C (2005). "Triple-X-Syndrome or Trisomy X" (PDF). Patient Care. 32 (6): 15–21. Archived from the original on 2011-07-24. Retrieved 2010-07-28. English translation from original Dutch by Jill Balfour.
  9. National Library of Medicine (2007). "Genetics Home Reference: Triple X syndrome". Archived from the original on 2007-03-12. Retrieved 2007-03-22.
  10. Jacobs, Patricia A.; Baikie, Albert G.; Court Brown, W. Michael; MacGregor, Thomas N.; Maclean, Neil; Harnden, David G. (September 26, 1959). "Evidence for the existence of the human 'super female'". The Lancet . 274 (7100): 423–425. doi:10.1016/S0140-6736(59)90415-5. PMID   14406377.
  11. Stern, Curt (December 12, 1959). "Use of the term 'superfemale'". The Lancet . 274 (7111): 1088. doi:10.1016/S0140-6736(59)91557-0.
    Jacobs, Patricia A.; Baikie, Albert G.; Court Brown, W. Michael; Harnden, David G.; MacGregor, Thomas N.; Maclean, Neil (December 19, 1959). "Use of the term 'superfemale'". The Lancet . 274 (7112): 1145. doi:10.1016/S0140-6736(59)90132-1.
    Jacobs, Patricia A. (March 3–5, 2006). "The discovery and history of Trisomy X and XYY syndrome". National Conference on Trisomy X and XYY, UC Davis M.I.N.D. Institute, Sacramento, California. DVD 02. Pine, Colorado: KS&A.
    Ferguson-Smith, Malcolm A. (December 2009). "It is 50 years since the discovery of the male determining role of the Y chromosome!". Sexual Development. 3 (5): 233–236. doi:10.1159/000252792. PMID   19844083. S2CID   207606694.
    Ferguson-Smith, Malcolm A. (September 2011). "Putting medical genetics into practice". Annual Review of Genomics and Human Genetics . 12: 1–23. doi:10.1146/annurev-genom-082410-101451. PMID   21639797.
  12. Lennox, Bernard (January 2, 1960). "Use of the term 'superfemale'". Lancet . 275 (7114): 55. doi:10.1016/S0140-6736(60)92744-6.
    Fraser, Jean H.; Campbell, John; MacGillivray, Ronald Charles; Boyd, Elizabeth; Lennox, Bernard (September 17, 1960). "The XXX syndrome: frequency among mental defectives and fertility". The Lancet . 276 (7151): 626–627. doi:10.1016/S0140-6736(60)91696-2. PMID   13701513.
    Anderson, John B.; Crofton, John (August 16, 1997). "Obituary: Bernard Lennox". BMJ . 315 (7105): 432. doi:10.1136/bmj.315.7105.432.
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