An Older Klinefelter's Syndrome Case with Bipolar Mood Disorder Living in Rural Area in Turkey

Aim:  The aim, in this case, is to report a patient with Klinefelter’s Syndrome, living in a rural area, at an advanced age having bipolar disorder.  Both of the diseases are usually supposed to be diagnosed earlier. Methods: The patient was evaluated when he visited the family physician in the rural area for follow-up of diabetes mellitus and psychotic disorder within the scope of mobile family medicine services. During the visit, abnormal body structure of the patient attracted notice and the patient further evaluated.  Results: Psychometric tests:  Young mania rating scale result was found to be 1/60 and the Hamilton depression rating scale result was found to be 27.  Measurements:  The body measurements of the patient were found to be as follows: height: 197 cm, weight: 129 kg, Body Mass Index: 33.3 kg/m 2 , arm span: 197 cm, pubis-to-floor: 107 cm, head-to-pubis: 90 cm, head circumference: 56.5 cm, waist circumference: 130 cm, hip circumference: 110 cm.  Laboratory:  The patient was diagnosed with pure KS by chromosome analysis of the peripheral blood.  Ultrasonography:  Scrotal doppler ultrasound examination revealed that the size of the right testicle was 20x8.5x12.5 mm (1.1 ml) and the size of the right testicle was 18x8x11 mm (0.8 ml) and both testicles were visualized to be hypoplastic. Conclusion: The chromosomal anomaly of the patient was diagnosed by a family doctor, who is also a part-time family medicine residency trainee, when the abnormal body structure, bipolar mood disorder, diabetes mellitus and infertility histories were associated. This case is a good example of the holistic approach. Rural medicine that is carried out in the form of mobile family practice in Turkey provided a significant contribution to the diagnosis of  Klinefelter’s Syndrome  in the patient. Amac: Bu olgu sunumunun amaci, kirsal bolgede yasayan, ileri yasta bipolar bozuklugu olan bir Klinefelter’s Sendromu olgusunu sunmaktir. Her iki hastaligin da daha erken ortaya cikmasi beklenirdi. Yontem: Hasta, Diabetes Mellitus ve psikiyatrik rahatsizligi sebebiyle, kirsal bolgede, aile hekimi ziyareti sirasinda degerlendirildi. Muayene sirasinda, anormal vucut yapisi dikkat cekti ve hasta ileri tetkik edildi. Sonuclar: Psikometrik testler: Young Mani olcegi 1/60 ve Hamilton Depresyon skalasi sonucu 27 bulundu. Olcumler: Hastanin vucut olculeri su sekildedir; boy: 197 cm, agirlik: 129 kg, Vucut Kitle Indeksi: 33,3 kg/m 2 , kulac uzunlugu: 197 cm, kalca cevresi: 110 cm. Laboratuar: Hastaya periferik kan kromozomal analizinde saf Klinefelter’s Sendromu olarak tani kondu. Ultrason: Skrotal ultrasonda sag testis buyuklugu 20x8,5x12,5 mm (1,1 ml) ve sol testis buyuklugu 18x8x11 mm (0,8 ml) olarak olculdu ve her iki testis hipoplazik olarak degerlendirildi. Sonuc: Kromozomal anomali, ayni zamanda yari zamanli aile hekimligi uzmanlik ogrencisi olan bir aile doktoru tarafindan, anormal vucut gorunumu, bipolar mizac bozuklugu, diabetes mellitus ve infertilite oykuleri birlestirilerek konulmustur. Bu olgu butuncul yaklasim icin guzel bir ornektir. Turkiye’de aile hekimleri tarafindan yurutulen kirsal hekimlik hizmetinin de bu hastada Klinefelter’s sendromu tanisi koymada katkisi vardir.