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XXXX syndrome

XXXX syndrome
Classification and external resources
Specialty medical genetics
ICD-10 Q97.1
DiseasesDB 32550
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XXXX syndrome (also called tetrasomy X, quadruple X, or 48, XXXX) is a rare chromosomal disorder caused by the presence of four X chromosomes instead of two X chromosomes. This condition occurs only in females, as there are no Y chromosomes present. Tetrasomy X was first described in 1961, and since then approximately 100 cases have been reported worldwide. Approximately 60 females have been described in medical literature with this condition.

Symptoms of tetrasomy X are highly variable, ranging from relatively mild to severe. Symptoms are often similar to those of trisomy X. Physically, tetrasomy X patients tend to have distinctive facial features such as epicanthal folds, flat nasal bridges, upslanting palpebral fissures, midface hypoplasia, small mouths, cleft or high arched palates, delayed or absent teeth, or enamel defects. The majority have also been reported as being longer and taller. Many also show joint and muscle tone abnormalities, including hypotonia and joint looseness in the hips. Skeletal problems may also be present, including abnormal curvatures of the spine. An informal study conducted by Tetrasomy & Pentasomy X Syndrome Information and Support found that 10% of girls had joint laxity in the hips and 20% had joint limitations in a sample size of 20 tetrasomy and pentasomy patients.

Developmentally, people with tetrasomy X frequently show mild delays in the areas of speech development and articulation, language expression and understanding, and reading skills. Delays in motor development are also present, with walking ages ranging from 16 months to 4.5 years. About 50% of patients undergo puberty normally, whereas the other 50% experiences no puberty, partial puberty without secondary sexual characteristics, or complete puberty with menstrual irregularities and/or early menopause (possibly as early as the teens). Medical literature reports four tetra-X pregnancies, two healthy, one with trisomy 21, one stillborn with omphalocele.


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