Wilson-Turner syndrome

The answer is d. (Murray, pp 812—828. Scriver, pp 3-45. Sack, pp 57-84. Wilson, pp 123—148.) The case described represents one of the more common chromosomal causes of reproductive failure. Turner mosaicism. Turner s syndrome represents a pattern of anomalies including short stature, heart defects, and infertility. Turner s syndrome is often associated with a 45,X karyotype (monosomy X) in females, but mosaicism (i.e., two or more cell lines with different karyotypes in the same individual) is common. However, chimerism (i.e., two cell lines in an individual arising from different zygotes, such as fraternal twins who do not separate) is extremely rare. Trisomy refers to three copies of one chromosome, euploidy to a normal chromosome number, and monoploidy to one set of chromosomes (haploidy in humans). 

The answer is e. (Murray, pp 812-828. Scriver, pp 3-45. Sack, pp 57-84. Wilson, pp 123-148.) Aneuploidy involves extra or missing chromosomes that do not arise as increments of the haploid chromosome number n. Polyploidy involves multiples of n, such as triploidy (3n = 69,XXX) or tetraploidy (4n = 92,XXXX). Diploidy (46,XX) and haploidy (23,X) are normal karyotypes in gametes and somatic cells, respectively. A 90,XX karyotype represents tetraploidy with two missing X chromosomes, which has been seen in one patient who had features that resembled those of Turner s syndrome. 

The answer is b. (Murray, pp 812—828. Scriver, pp 3—45. Sack, pp 57-84. Wilson, pp 123-148.) Cytogenetic notation provides the chromosome number (e.g., 46), the sex chromosomes, and a shorthand description of anomalies. Examples include the following 45,X indicates a female with monosomy X or Turner s syndrome 47,XX-I-2I indicates a female with trisomy 21 or Down s syndrome 46,XX,t(14 21) indicates a female with translocation Down s syndrome 45,XX—21 indicates a female with mono-... 

The answer is e. (Murray, pp 812-828. Scriver, pp 3-45. Sack, pp 57-84. Wilson, pp 123-148.) Children with chromosome abnormalities often exhibit poor growth (failure to thrive) and developmental delay with an abnormal facial appearance. This baby is too young for developmental assessment, but the catlike cry should provoke suspicion of cri-du-chat syndrome. Cri-du-chat syndrome is caused by deletion of the terminal short arm of chromosome 5 [46,XX,del(5p), also abbreviated as 5p—] as depicted in panel e. When a partial deletion or duplication like this one is found, the parents must be karyotyped to determine if one carries a balanced reciprocal translocation. The other karyotypes show (a) deletion of the short arm of chromosome 4 [46,XY,del(4p) or 4p—] (b) XYY syndrome (47,XYY) (c) deletion of the long arm of chromosome 13 [46,XX,del(13q) or 13q-] (d) Klinefelter s syndrome (47,XXY). Most disorders involving excess or deficient chromosome material produce a characteristic and recognizable phenotype (e.g., Down s, cri-du-chat, or Turner s syndrome). The deletion of 4p- (panel A) produces a pattern of abnormalities (syndrome) known as Wolf-Hirschhorn syndrome deletion of 13q- produces a 13q— syndrome (no eponym). The mechanism(s) by which imbalanced chromosome material produces a distinctive phenotype is completely unknown. 

The answer is a. (Murray, pp 812-828. Scriver, pp 3-45. Sack, pp 97-158. Wilson, pp 23—39.) Females have two alleles for each locus on the X chromosome because of their 46,XX karyotype. One normal allele is by definition sufficient for normal function in X-linked recessive disorders, so that females with one abnormal allele are carriers instead of affected individuals. Only when the companion normal allele is disrupted or missing does the abnormal allele cause disease. The Lyon hypothesis predicts that X inactivation is early, irreversible, and random, but some females inactivate only the X chromosome carrying the normal allele. X autosome translocations may disrupt an X chromosome locus and cause disease because the translocated autosome must remain active to avert embryonic death nonrandom inactivation of the normal X chromosome thus ablates expression of its normal allele. Females with Turner s syndrome, like males with 46,XY karyotypes, have only one X chromosome and can be affected with X-linked recessive diseases. Conversely, females with triple X or trisomy X syndrome have three alleles at each X chromosome locus and are not affected with X-linked recessive disorders. Since choices c, d, and e each require two genetic changes, they are less common than choice a. 

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