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No HPO annotations are available for this condition.
Males with X-linked agammaglobulinemia (XLA) are usually well for the first few months of life because they are protected by transplacentally acquired maternal immunoglobulin. Typically, affected males develop recurrent bacterial infections in the first two years of life and are recognized as having immunodeficiency before age five years . Recurrent otitis is the most common infection prior to diagnosis. Conjunctivitis, sinopulmonary infections, diarrhea, and skin infections are also frequently seen. Approximately 60% of individuals with XLA are recognized as having immunodeficiency when they develop a severe, life-threatening infection such as pneumonia, empyema, meningitis, sepsis, cellulitis, or septic arthritis.
X-linked agammaglobulinemia (XLA) should be suspected in probands with the following clinical, laboratory, and family history findings.
Clinical findings
Recurrent otitis, pneumonitis, sinusitis, and conjunctivitis starting before age five years
A severe life-threatening bacterial infection such as sepsis, meningitis, cellulitis, or empyema
4 FDA-approved treatments are available for isolated congenital growth hormone deficiency, including SOMATROGON-GHLA (NGENLA, approved 2023), LONAPEGSOMATROPIN-TCGD (SKYTROFA, approved 2021), and SOMAPACITAN-BECO (SOGROYA, approved 2020).
Brand Name | Generic Name | Mechanism | Approved | Market Status |
|---|
To monitor existing manifestations, the individual's response to supportive care, and the emergence of new manifestations, the evaluations summarized in are recommended.
Table 6.
X-Linked Agammaglobulinemia: Recommended Surveillance
System/Concern | Evaluation | Frequency
| • CBC w/differential
2 clinical trials registered. Interventions under study include other interventions. Pipeline includes 1 NA. Research is primarily sponsored by academic and government institutions.
10 publications have been identified in PubMed for isolated congenital growth hormone deficiency. Research spans Case Report / Case Series (30%), Epidemiology / Natural History (20%), and Other (10%).
Research Type | Count | % of Total |
|---|---|---|
Patient case studies | 3 | 30% |
Data assembled from 6 of 12 sources · Last updated Sep 20, 2026, 1:03 AM UTC
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Source: GeneReviews — "X-Linked Agammaglobulinemia"
Paucity of lymphoid tissue (small adenoids, tonsils, and lymph nodes on physical examination)
Laboratory findings
Source: GeneReviews — "X-Linked Agammaglobulinemia"
X-linked agammaglobulinemia (XLA) is the most common cause of agammaglobulinemia, accounting for approximately 85% of individuals with early onset of infections, panhypogammaglobulinemia, and markedly reduced numbers of B lymphocytes (CD19+ cells) in the peripheral circulation (2%) . The majority of females with an XLA-like phenotype and males with an XLA phenotype who do not have an identifiable BTK pathogenic variant are likely to have defects in other genes required for normal B cell development . These forms of agammaglobulinemia are very rare. Individuals with agammaglobulinemia caused by pathogenic variants in genes other than BTK cannot be distinguished by routine clinical or laboratory tests from individuals with XLA . These disorders should be considered in females who have an XLA-like phenotype or in males who were presumed to have XLA but who do not have a pathogenic variant in BTK. Families with a known history of consanguinity are more likely to have rare autosomal recessive forms of agammaglobulinemia than XLA. The underlying defect remains unknown in a small percentage of individuals with congenital agammaglobulinemia and absent B cells . Table 2. X-Linked Agammaglobulinemia: Genes of Interest in the Differential Diagnosis of Congenital Agammaglobulinemia and Absent B Cells
Gene1 | Disorder1 | MOI |
|---|---|---|
BLNK | BLNK deficiency | AR |
CD79A | Ig alpha (Ig) deficiency | AR |
CD79B | Ig beta (Ig) deficiency | AR |
FNIP1 | FNIP1 deficiency | AR |
IGHM | Mu heavy chain deficiency2 | AR |
IGLL1 | Lambda 5 (5) deficiency | AR |
PIK3CD | p110 delta (p110) deficiency | AR |
PIK3R1 | p85 deficiency | AR |
SLC39A7 | SLC39A7 (ZIP7) deficiency | AR |
SPI1 | PU1 deficiency | AD |
TCF3 | E47 transcription factor deficiency | ADAR |
TOP2B | Hoffman syndrome/ TOP2B deficiency | AD AD = autosomal dominant, AR = autosomal recessive; MOI = mode of inheritance 1. , At least 30 individuals with more than 20 different pathogenic variants in IGHM have been reported . |
Source: GeneReviews — "X-Linked Agammaglobulinemia"
Biomarker and diagnostic research for isolated congenital growth hormone deficiency has been reported in the published literature.
NGENLA | SOMATROGON-GHLA | — | 2023 | Available |
SKYTROFA | LONAPEGSOMATROPIN-TCGD | — | 2021 | Available |
SOGROYA | SOMAPACITAN-BECO | — | 2020 | Available |
MACRILEN | MACIMORELIN ACETATE | — | 2017 | Available |
No clinical practice guidelines specific for X-linked agammaglobulinemia (XLA) have been published. In the absence of published guidelines, the following recommendations are based on the authors' personal experience managing individuals with this disorder. Evaluations Following Initial Diagnosis To establish the extent of disease and needs in an individual diagnosed with XLA, the evaluations summarized (if not performed as part of the evaluation that led to the diagnosis) are recommended. Table 3. X-Linked Agammaglobulinemia: Recommended Evaluations Following Initial Diagnosis
System/Concern | Evaluation | Comment |
|---|---|---|
Respiratory | Baseline chest sinus radiographs | Baseline pulmonary function tests |
Genetic counseling | By genetics professionals1 | To obtain a pedigree inform affected persons their families re nature, MOI, implications of XLA to facilitate medical personal decision making CBC = complete blood count; CRP = C-reactive protein; MOI = mode of inheritance; XLA = X-linked agammaglobulinemia 1. |
X-Linked Agammaglobulinemia: Targeted Therapy Treatment Class | Treatment | Considerations/Other |
Replacement therapy | Gammaglobulin substitution therapy (by weekly subcutaneous injection or intravenous infusion every 2-4 weeks) to prevent bacterial infections | Mainstay of treatment for persons w/XLA Gammaglobulin substitution therapy is the mainstay of treatment for individuals with XLA. Most individuals in the United States are given approximately 400 mg/kg of gammaglobulin every four weeks. |
X-Linked Agammaglobulinemia: Treatment of Manifestations Manifestation/Concern | Treatment | Considerations/Other |
Acute infections | Antibiotic treatment that is at least twice as long as that used in otherwise healthy persons | Generous use of antibiotics is recommended treatment should be given w/o unnecessary delay. |
Risk of bacterial infections | Prophylactic antibiotics are used in some centers for prevention of bacterial infections. | Amoxicillin combined w/clavulanic acid (an inhibitor of beta-lactamase enzyme) can be used, or alternatively sulfamethoxazole trimethoprim. Ciprofloxacin may be used as a third option. Vaccines, apart from live vaccines, are recommended.1 |
Risk assoc w/live vaccines | Children w/XLA should only be given inactivated polio vaccine (IPV). | The sibs of children w/XLA should also be given IPV rather than oral polio vaccine (OPV) to avoid infecting their affected sib w/live polio virus. 1. |
Source: GeneReviews — "X-Linked Agammaglobulinemia"
Live viral vaccines, particularly oral polio vaccine, should be avoided in individuals with XLA.
Source: GeneReviews — "X-Linked Agammaglobulinemia"
Research studies exploring virus-mediated and oligonucleotide gene therapy for XLA have been conducted in mice [, , , ], but it is not clear when this type of treatment may be available for humans. Gene editing of hematopoietic stem cells is also being developed but to date is not clinically available for XLA treatment . Search ClinicalTrials.gov in the US and EU Clinical Trials Register in Europe for access to information on clinical studies for a wide range of diseases and conditions.
Source: GeneReviews — "X-Linked Agammaglobulinemia"
2 trials found
Quantitative serum immunoglobulins to monitor gammaglobulin substitution therapy1
| At least annually
| • Chest radiographs or chest CT to assess for chronic lung disease
Sinus imaging
| As needed
CBC = complete blood count
1. If the individual is stable, the serum IgG does not need to be evaluated with every infusion of gammaglobulin.
Source: GeneReviews — "X-Linked Agammaglobulinemia"
Estimated prevalence: 1-5 in 10,000 (Uncommon).
Disease patterns and progression |
2 |
20% |
Other research | 1 | 10% |
Testing and diagnosis research | 1 | 10% |
Research summaries | 1 | 10% |
Clinical study results | 1 | 10% |
Laboratory research | 1 | 10% |
Campos VC (2026). [PMID: 41528724](https://pubmed.ncbi.nlm.nih.gov/41528724/). *European journal of endocrinology*. [Basic Science / Preclinical]
Van de Velde S (2026). [PMID: 42143199](https://pubmed.ncbi.nlm.nih.gov/42143199/). *Eur J Pediatr*. [Epidemiology / Natural History]
Aguilar-Riera C (2025). [PMID: 40598088](https://pubmed.ncbi.nlm.nih.gov/40598088/). *BMC endocrine disorders*. [Epidemiology / Natural History]
Noorian S (2025). [PMID: 39980897](https://pubmed.ncbi.nlm.nih.gov/39980897/). *Clinical case reports*. [Case Report / Case Series]
Yin H (2025). [PMID: 41811041](https://pubmed.ncbi.nlm.nih.gov/41811041/). *Zhonghua yi xue yi chuan xue za zhi = Zhonghua yixue yichuanxue zazhi = Chinese journal of medical genetics*. [Case Report / Case Series]
Huang X (2024). [PMID: 39435354](https://pubmed.ncbi.nlm.nih.gov/39435354/). *Frontiers in endocrinology*. [Case Report / Case Series]
Yuen KCJ (2024). [PMID: 39665021](https://pubmed.ncbi.nlm.nih.gov/39665021/). *Frontiers in endocrinology*. [Review / Meta-Analysis]
Santos LB (2024). [PMID: 39420931](https://pubmed.ncbi.nlm.nih.gov/39420931/). *Archives of endocrinology and metabolism*. [Diagnostic / Biomarker]
Guo X (2024). [PMID: 38492309](https://pubmed.ncbi.nlm.nih.gov/38492309/). *Endocrine connections*. [Clinical Trial Publication]
Omar I (2024). [PMID: 39578934](https://pubmed.ncbi.nlm.nih.gov/39578934/). *International journal of retina and vitreous*. [Other]