title: Endocrine abnormalities in ring chromosome 11: a case report and review of the literature.
abstract: Ring chromosomes (RCs) are uncommon cytogenetic findings, and RC11 has only been described in 19 cases in the literature. Endocrine abnormalities associated with RC11 were reported for two of these cases. The clinical features of RC11 can result from an alteration in the structure of the genetic material, ring instability, mosaicism, and various extents of genetic material loss. We herein describe a case of RC11 with clinical features of 11q-syndrome and endocrine abnormalities that have not yet been reported. A 20-year-old female patient had facial dysmorphism, short stature, psychomotor developmental delays, a ventricular septal defect, and thrombocytopenia. Karyotyping demonstrated RC11 (46,XX,r(11)(p15q25)). This patient presented with clinical features that may be related to Jacobsen syndrome, which is caused by partial deletion of the long arm of chromosome 11. Regarding endocrine abnormalities, our patient presented with precocious puberty followed by severe hirsutism, androgenic alopecia, clitoromegaly, and amenorrhea, which were associated with overweight, type 2 diabetes mellitus (T2DM), and hyperinsulinemia; therefore, this case meets the diagnostic criteria for polycystic ovary syndrome. Endocrine abnormalities are rare in patients with RC11, and the association of RC11 with precocious puberty, severe clinical hyperandrogenism, insulin resistance, and T2DM has not been reported previously. We speculate that gene(s) located on chromosome 11 might be involved in the pathogenesis of these conditions. Despite the rarity of RCs, studies to correlate the genes located on the chromosomes with the phenotypes observed could lead to major advances in the understanding and treatment of more prevalent diseases.
  
  
  CONCLUSIONS
  We hypothesize that the endocrine features of precocious puberty, severe clinical hyperandrogenism, insulin resistance, and T2DM might be associated with 11q-syndrome.A karyotype study should be performed in patients with short stature and facial dysmorphism.Early diagnosis and adequate management of these endocrine abnormalities are essential to improve the quality of life of the patient and to prevent other chronic diseases, such as diabetes and its complications.
authors.affiliation: Endocrine Section, Hospital Federal da Lagoa , Rio de Janeiro , Brazil.
authors.forename: Renata
authors.initials: R
authors.lastname: Lange
authors.affiliation: Endocrine Section, Hospital Federal da Lagoa , Rio de Janeiro , Brazil.
authors.forename: Caoê
authors.initials: C
authors.lastname: Von Linsingen
authors.affiliation: Endocrine Section, Hospital Federal da Lagoa , Rio de Janeiro , Brazil.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Mata
authors.affiliation: Department of Internal Medicine and Endocrine Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal de Rio de Janeiro , Rua Prof. Rodolpho Paulo Rocco, 255, 9th Floor, Ilha do Fundão, Rio de Janeiro, 21941-913 , Brazil.
authors.forename: Aline Barbosa
authors.initials: AB
authors.lastname: Moraes
authors.affiliation: Department of Internal Medicine and Endocrine Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal de Rio de Janeiro , Rua Prof. Rodolpho Paulo Rocco, 255, 9th Floor, Ilha do Fundão, Rio de Janeiro, 21941-913 , Brazil.
authors.forename: Mariana
authors.initials: M
authors.lastname: Arruda
authors.affiliation: Endocrine Section, Hospital Federal da Lagoa , Rio de Janeiro , Brazil ; Department of Internal Medicine and Endocrine Section, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal de Rio de Janeiro , Rua Prof. Rodolpho Paulo Rocco, 255, 9th Floor, Ilha do Fundão, Rio de Janeiro, 21941-913 , Brazil.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Vieira Neto