Familial male pseudohermaphroditism

Hypospadias and variants in genes related to sex hormone biosynthesis and metabolism

We examined whether variants in genes related to sex hormone biosynthesis and metabolism were associated with hypospadias in humans. We examined 332 relatively common tag single-nucleotide polymorphisms (tagSNPs) in 20 genes. Analyses included 633 cases (84 mild, 322 moderate, 212 severe and 15 undetermined severity) and 855 population-based non-malformed male controls born in California from 1990 to 2003. We used logistic regression models to estimate odds ratios (OR) and 95% confidence intervals (CI) for each SNP. Several of the 332 studied SNPs had p < 0.01: one in CYP3A4, four in HSD17B3, one in HSD3B1, two in STARD3, 10 in SRD5A2 and seven in STS. In addition, haplotype analyses gave several associations with p < 0.01. For HSD17B3, 14-SNP and 5-SNP blocks had ORs of 1.5 (95% CI 1.1, 2.0, p < 0.001) and 2.8 (95% CI 1.6, 4.8, p < 0.001) respectively. For SRD5A2, 9-SNP, 3-SNP and 8-SNP blocks had ORs of 1.7 (95% CI 1.3, 2.2, p < 0.001), 1.4 (95% CI 1.1, 1.8, p = 0.008) and 1.5 (95% CI 1.2, 1.9, p = 0.002) respectively. Our study indicates that several genes that contribute to sex hormone biosynthesis and metabolism are associated with hypospadias risk.

Bifid liver presenting with anomalous quadrate and caudate lobes and a transverse gallbladder

The current Observation reports multiple anomalies of the liver of a 55-year-old male cadaver. Observations revealed the presence of anomalies on the diaphragmatic and visceral surfaces of the liver. The diaphragmatic surface presented with a deep furrow that run obliquely from the fissure for the inferior vena cava to the inferior border of the liver. It divided the liver partially into the right and left segments that remained united by the liver tissue that measured about 0.7 cm thick. The two segments were easily pulled apart for up to 3 cm. A similar fissure did not appear on the visceral surface. The visceral surface presented with multiple anomalies that included a vertically oriented porta hepatis, abnormal Y-shaped fissures on the right lobe, transverse gallbladder, absence of the caudate process on the caudate lobe, abnormal quadrate lobe, and transverse fissure on the right lobe. The three fissures that formed a Y-shaped configuration delineated the quadrate lobe. The right and left arms of the Y-shaped fissure terminated in the porta hepatis. Congenital anomalies of the adult liver are rare; therefore continued documentation of such anomalies remains to be important in medical sciences and in the understanding of liver ontogeny.

Etiology, clinical profile, gender identity and long-term follow up of patients with ambiguous genitalia in India

There is little information on the profile of children with ambiguous genitalia in India. Presented here is an analysis of patients with ambiguous genitalia registered in a general endocrine clinic during the last 2 decades. Seventy-four patients (age 4 months to 36 years) were registered during this period. Fifty-two were more than 5 years old at the time of registration. Thirty-five were reared as females, 29 as males; nine children (4 months to 1 year old) were brought for sex assignment, and one (with epispadias) was brought for correction of urinary incontinence. Investigations revealed 28 patients with congenital adrenal hyperplasia, 14 dysgenetic male pseudohermaphroditism, ten true hermaphroditism, six partial androgen insensitivity, four castration and one epispadias. There were eight patients with perineal hypospadias with normal Leydig cell reserve (normal LH, FSH and testosterone response to LHRH). Sex of rearing and gender identity were concordant in all except the patients with perineal hypospadias with normal Leydig cell response. These observations support the theory that prenatal androgen exposure masculinizes the brain.