Clinical but Not Histological Outcomes in Males With 45,X/46,XY Mosaicism Vary Depending on Reason for Diagnosis

Marie Lindhardt Ljubicic, Anne Jørgensen, Carlo Acerini, Juliana Andrade, Antonio Balsamo, Silvano Bertelloni, Martine Cools, Rieko Tadokoro Cuccaro, Feyza Darendeliler, Christa E Flück, Romina P Grinspon, Andrea Maciel-Guerra, Tulay Guran, Sabine E Hannema, Angela K Lucas-Herald, Olaf Hiort, Paul Martin Holterhus, Corina Lichiardopol, Leendert H J Looijenga, Rita OrtolanoStefan Riedl, S Faisal Ahmed, Anders Juul

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)


CONTEXT: Larger studies on outcomes in males with 45,X/46,XY mosaicism are rare.

OBJECTIVE: To compare health outcomes in males with 45,X/46,XY diagnosed as a result of either genital abnormalities at birth or nongenital reasons later in life.

DESIGN: A retrospective, multicenter study.

SETTING: Sixteen tertiary centers.

PATIENTS OR OTHER PARTICIPANTS: Sixty-three males older than 13 years with 45,X/46,XY mosaicism.

MAIN OUTCOME MEASURES: Health outcomes, such as genital phenotype, gonadal function, growth, comorbidities, fertility, and gonadal histology, including risk of neoplasia.

RESULTS: Thirty-five patients were in the genital group and 28 in the nongenital. Eighty percent of all patients experienced spontaneous pubertal onset, significantly more in the nongenital group (P = 0.023). Patients were significantly shorter in the genital group with median adult heights of 156.7 cm and 164.5 cm, respectively (P = 0.016). Twenty-seven percent of patients received recombinant human GH. Forty-four patients had gonadal histology evaluated. Germ cells were detected in 42%. Neoplasia in situ was found in five patients. Twenty-five percent had focal spermatogenesis, and another 25.0% had arrested spermatogenesis. Fourteen out of 17 (82%) with semen analyses were azoospermic; three had motile sperm.

CONCLUSION: Patients diagnosed as a result of genital abnormalities have poorer health outcomes than those diagnosed as a result of nongenital reasons. Most patients, however, have relatively good endocrine gonadal function, but most are also short statured. Patients have a risk of gonadal neoplasia, and most are azoospermic, but almost one-half of patients has germ cells present histologically and up to one-quarter has focal spermatogenesis, providing hope for fertility treatment options.

Original languageEnglish
Pages (from-to)4366-4381
Number of pages16
JournalThe Journal of clinical endocrinology and metabolism
Issue number10
Publication statusPublished - 1 Oct 2019
Externally publishedYes


  • Adolescent
  • Adult
  • Biopsy, Needle
  • Cohort Studies
  • Genitalia, Male/abnormalities
  • Gonadal Dysgenesis, 46,XY/epidemiology
  • Gonads/pathology
  • Humans
  • Immunohistochemistry
  • Karyotyping
  • Male
  • Mosaicism
  • Phenotype
  • Quality of Life
  • Registries
  • Retrospective Studies
  • Semen Analysis/methods
  • Sex Characteristics
  • Sex Chromosome Aberrations
  • Spermatogenesis/genetics
  • Turner Syndrome/epidemiology
  • Young Adult


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