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Tetrasomy X

Synonym(s) 48,XXXX syndrome
Quadruple X
Tetra X
Prevalence <1 / 1 000 000
Inheritance -
Age of onset Infancy
  • Q97.1
  • C0265496
  • C536502
MedDRA -


Disease definition

Tetrasomy X is a sex chromosome anomaly caused by the presence of two extra X chromosomes in females (48,XXXX instead of 46,XX).


Prevalence is unknown but only around 40 cases have been reported in the literature so far.

Clinical description

Tetrasomy X is associated with delayed speech, learning difficulties, developmental delay and facial dysmorphism. Although disease severity is variable, the learning difficulties and developmental delay are generally mild to moderate. Commonly associated facial features include hypertelorism, upslanting palpebral fissures, epicanthal folds and a flat nasal bridge. Other anomalies may include dental abnormalities, hypotonia and joint laxity, radioulnar synostosis, heart defects, hip dysplasia, and ovarian dysfunction. An increased susceptibility to infections during childhood has also been reported.


Tetrasomy X is generally thought to arise as a result of successive maternal nondisjunction during meiosis.

Expert reviewer(s)

  • Dr Natalie AYARI
  • Dr A BERGE
  • Dr Susan HOWELL
  • Dr Nicole TARTAGLIA

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