Klinefelter (47, XXY) syndrome (KS), the most common form of sex-chromosomal aneuploidy, is characterized by physical, endocrinologic, and reproductive abnormalities. Individuals with KS also exhibit a cognitive/behavioral phenotype characterized by language and language-based learning disabilities and executive and attentional dysfunction in the setting of normal general intelligence. The underlying neurobiologic mechanisms are just now beginning to be elucidated through structural and functional neuroimaging. Here, we review the literature of structural and functional neural findings in KS identified by neuroimaging and present preliminary results from a functional magnetic resonance imaging study examining brain activity during a verb generation task in KS.
KeywordsKlinefelter syndrome; XXY; MRI; neuroimage; Magnetic Resonance Imaging; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-PhotonThe 47, XXY karyotype is the most common form of sex-chromosomal aneuploidy, with an estimated prevalence in the general population between one in 500 and one in 1000 [Lanfranco et al., 2004]. The clinical manifestations associated with this genotype are referred to as Klinefelter syndrome (KS). Characteristic physical and medical attributes of infertility, small testes, gynecomastia, and tall body habitus with long legs are thought to result from testosterone deficiency [Wattendorf and Muenke, 2005]. Individuals with KS also exhibit a characteristic pattern of cognitive and behavioral dysfunction [Geschwind et al., 2000], which is reviewed
NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript in depth in another article in this issue [Boada et al., 2009]. In brief, the cognitive/behavioral phenotype includes language and language-based learning disabilities (similar to that observed in cytogenetically-normal children with dyslexia) as well as executive and attentional dysfunction [Lanfranco et al., 2004]. General intelligence appears to be within the typical range in men with KS, though global developmental delays in childhood include delayed language and (gross and fine) motor development [Wattendorf and Muenke, 2005].Though a characteristic KS cognitive phenotype is now recognized, relatively little is known about the underlying neural mechanisms [Geschwind et al., 2000;Reiss et al., 2000;Geschwind and Dykens, 2004;Giedd et al., 2007;van Rijn et al., 2008]. In this article, we review the current literature of studies beyond case-report status that used structural and functional neuroimaging techniques to further understanding of the neurobiologic mechanisms underlying cognitive and behavioral differences in KS. We begin by presenting studies of volumetric differences in KS, organized by neuroanatomic level of the brain findings, including (1) widespread brain differences and differences in ventricular size; (2) cerebral lobar and cerebellar differences; (3) differences in intra-individual asymmetries; and (4) regional differences. This is followed by a section discussing f...