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Unusual presentation of Kallmannn syndrome with contiguous gene deletion in three siblings of a family.
[kallmann syndrome]
We
report
the
case
of
3
brothers
aged
34
,
24
,
and
22
years
,
unmarried
,
who
presented
to
our
endocrinology
clinic
with
absence
of
secondary
sexual
characters
.
There
was
no
such
history
in
other
siblings
,
but
their
maternal
uncle
had
similar
complaints
.
On
examination
,
all
3
had
pre-pubertal
appearance
,
voice
,
and
genitalia
along
with
anosmia
and
bimanual
synkinesia
.
Cryptorchidism
was
noticed
in
2
while
third
person
had
small
hypoplastic
testes
.
It
was
also
noted
that
all
3
patients
had
icthyosis
mainly
involving
trunk
,
back
,
and
limbs
.
The
hormonal
assays
were
consistent
with
isolated
hypogonadotrophic
hypogonadism
.
IQ
testing
revealed
mental
retardation
in
the
2
patients
.
Ultrasound
showed
ectopic
right
kidney
in
one
patient
,
atrophic
right
kidney
in
the
second
patient
while
the
third
patient
had
normal
kidneys
.
MRI
brain
of
all
the
patients
showed
poorly
visualized
olfactory
tract
and
bulb
.
Kallmann
syndrome
(
KS
)
was
diagnosed
based
on
hormonal
evaluation
and
MRI
results
.
Of
the
four
types
of
KS
:
Synkinesia
,
renal
anomaly
,
and
X-
linked
pedigree
pattern
in
our
patients
pointed
towards
X-
linked
type
1
KS
as
the
possible
cause
.
But
,
icthyosis
and
mental
retardation
are
not
usual
presentation
of
type
1
KS
.
They
are
usually
seen
as
a
result
of
contiguous
gene
deletion
of
KAL
1
,
steroid
sulfatase
(
STS
)
,
and
mental
retardation
(
MRX
)
gene
on
X
chromosome
.
Hence
,
the
possible
gene
defect
in
our
cases
is
inherited
defect
in
contiguous
gene
deletion
.
The
contiguous
gene
deletion
as
the
cause
of
KS
in
3
patients
of
same
family
is
very
rare
and
worth
reporting
.
Also
,
the
significance
of
phenotype-genotypic
association
in
Kallmann
syndrome
is
discussed
.
Diseases
Validation
Diseases presenting
"hypoplastic testes"
symptom
kallmann syndrome
This symptom has already been validated