P. Martul et al., HYPOGONADOTROPIC HYPOGONADISM WITH HYPOSMIA, X-LINKED ICHTHYOSIS, ANDRENAL MALFORMATION SYNDROME, Clinical endocrinology, 42(2), 1995, pp. 121-128
OBJECTIVE The aim of this study was the endocrinological, enzymatic, a
nd genetic evaluation of a family with a complex syndrome associating
hypogonadotrophic hypogonadism with hyposmia, X-linked ichthyosis and
renal malformation. DESIGN Hypothalamic-pituitary-testicular function,
olfaction, steroid sulphatase activity, and morphological renal studi
es were assessed, DNA molecular analyses were carried out in all the p
atients. PATIENTS Two brothers and their maternal uncle showed the cli
nical picture of congenital ichthyosis, hypogonadism, hyposmia and uni
lateral renal maldevelopment. MEASUREMENTS LH and FSH were determined
by RIA basally and after GnRH stimulation, and the test repeated after
a period of GnRH priming. Testosterone response to hCG was measured.
Arylsulphatase C assay was performed as a measure of steroid sulphatas
e activity. DNA amplification analysis and Southern blot analysis of f
our Xp22.3 loci were performed. RESULTS Low levels of gonadotophins, b
asally and after acute GnRH, increased clearly after GnRH priming. Low
testosterone levels increased promptly after hCG. Subnormal levels of
arylsulphatase C were detected. Hyposmia and renal hypoplasia or apla
sia were demonstrated. A large Xp 22.3 deletion including the genes re
sponsible for X-linked ichthyosis (steroid sulphatase deficiency) and
Kallmann syndrome was demonstrated. CONCLUSIONS The absence of the gen
e encoding steroid sulphatase accounts for the X-linked ichthyosis in
these patients, whereas the absence of the Kallmann syndrome gene acco
unts for hypogonadism, anosmia and for the single kidney found in two
of the three patients.