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Katsimperis S, Kapriniotis K, Manolitsis I, Bellos T, Angelopoulos P, Juliebø-Jones P, Somani B, Skolarikos A, Tzelves L. Early investigational agents for the treatment of benign prostatic hyperplasia'. Expert Opin Investig Drugs 2024; 33:359-370. [PMID: 38421373 DOI: 10.1080/13543784.2024.2326023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/28/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH), as a clinical entity that affects many people, has always been in the forefront of interest among researchers, pharmaceutical companies, and physicians. Patients with BPH exhibit a diverse range of symptoms, while current treatment options can occasionally cause adverse events. All the aforementioned have led to an increased demand for more effective treatment options. AREAS COVERED This review summarizes the outcomes of new medications used in a pre-clinical and clinical setting for the management of male lower urinary tract symptoms (LUTS)/BPH and provides information about ongoing trials and future directions in the management of this condition. More specifically, sheds light upon drug categories, such as reductase‑adrenoceptor antagonists, drugs interfering with the nitric oxide (NO)/cyclic guanosine monophosphate (GMP) signaling pathway, onabotulinumtoxinA, vitamin D3 (calcitriol) analogues, selective cannabinoid (CB) receptor agonists, talaporfin sodium, inhibitor of transforming growth factor beta 1 (TGF-β1), drugs targeting the hormonal control of the prostate, phytotherapy, and many more. EXPERT OPINION Clinical trials are being conducted on a number of new medications that may emerge as effective therapeutic alternatives in the coming years.
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Affiliation(s)
- Stamatios Katsimperis
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ioannis Manolitsis
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Themistoklis Bellos
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Angelopoulos
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Andreas Skolarikos
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lazaros Tzelves
- 2nd University Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Department of Urology, University College of London Hospitals (UCLH), London, UK
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Kouri C, Sommer G, Martinez de Lapiscina I, Elzenaty RN, Tack LJW, Cools M, Ahmed SF, Flück CE. Clinical and genetic characteristics of a large international cohort of individuals with rare NR5A1/SF-1 variants of sex development. EBioMedicine 2024; 99:104941. [PMID: 38168586 PMCID: PMC10797150 DOI: 10.1016/j.ebiom.2023.104941] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Steroidogenic factor 1 (SF-1/NR5A1) is essential for human sex development. Heterozygous NR5A1/SF-1 variants manifest with a broad range of phenotypes of differences of sex development (DSD), which remain unexplained. METHODS We conducted a retrospective analysis on the so far largest international cohort of individuals with NR5A1/SF-1 variants, identified through the I-DSD registry and a research network. FINDINGS Among 197 individuals with NR5A1/SF-1 variants, we confirmed diverse phenotypes. Over 70% of 46, XY individuals had a severe DSD phenotype, while 90% of 46, XX individuals had female-typical sex development. Close to 100 different novel and known NR5A1/SF-1 variants were identified, without specific hot spots. Additionally, likely disease-associated variants in other genes were reported in 32 individuals out of 128 tested (25%), particularly in those with severe or opposite sex DSD phenotypes. Interestingly, 48% of these variants were found in known DSD or SF-1 interacting genes, but no frequent gene-clusters were identified. Sex registration at birth varied, with <10% undergoing reassignment. Gonadectomy was performed in 30% and genital surgery in 58%. Associated organ anomalies were observed in 27% of individuals with a DSD, mainly concerning the spleen. Intrafamilial phenotypes also varied considerably. INTERPRETATION The observed phenotypic variability in individuals and families with NR5A1/SF-1 variants is large and remains unpredictable. It may often not be solely explained by the monogenic pathogenicity of the NR5A1/SF-1 variants but is likely influenced by additional genetic variants and as-yet-unknown factors. FUNDING Swiss National Science Foundation (320030-197725) and Boveri Foundation Zürich, Switzerland.
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Affiliation(s)
- Chrysanthi Kouri
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland; Department for BioMedical Research, University of Bern, Bern 3008, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern 3012, Switzerland
| | - Grit Sommer
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland; Department for BioMedical Research, University of Bern, Bern 3008, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Switzerland, University of Bern, Bern 3012, Switzerland
| | - Idoia Martinez de Lapiscina
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland; Department for BioMedical Research, University of Bern, Bern 3008, Switzerland; Research into the Genetics and Control of Diabetes and Other Endocrine Disorders, Biobizkaia Health Research Institute, Cruces University Hospital, Barakaldo 48903, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid 28029, Spain; CIBER de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid 28029, Spain; Endo-ERN, Amsterdam 1081 HV, the Netherlands
| | - Rawda Naamneh Elzenaty
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland; Department for BioMedical Research, University of Bern, Bern 3008, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern 3012, Switzerland
| | - Lloyd J W Tack
- Department of Paediatric Endocrinology, Department of Paediatrics and Internal Medicine, Ghent University Hospital, Ghent University, Ghent 9000, Belgium
| | - Martine Cools
- Department of Paediatric Endocrinology, Department of Paediatrics and Internal Medicine, Ghent University Hospital, Ghent University, Ghent 9000, Belgium
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Sick Children, Glasgow G51 4TF, UK
| | - Christa E Flück
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland; Department for BioMedical Research, University of Bern, Bern 3008, Switzerland.
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Noroozi Asl S, Ibrahimi R, Bagheri S, Lotfi M. 5-Alpha reductase deficiency; an important cause of 46, XY DSD: Report of three cases within a family. Clin Case Rep 2023; 11:e7269. [PMID: 37180321 PMCID: PMC10172458 DOI: 10.1002/ccr3.7269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/27/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
Key clinical message 5-Alpha reductase deficiency is an important cause of 46, XY disorder of sex development. Timely diagnosis and proper management by a multidisciplinary team can lead to a favorable outcome. Sex assignment should be deferred until puberty because spontaneous virilization occurs and the patient can engage in the decision-making process. Abstract 5-Alpha reductase deficiency is a genetic disorder causing 46, XY disorder of sex development (DSD). Typical clinical feature is a male with ambiguous genitalia or undervirilization at birth. Here we report three cases of this disorder within a family.
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Affiliation(s)
- Samaneh Noroozi Asl
- Department of Pediatrics, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Reza Ibrahimi
- Student Research Committee, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Sepideh Bagheri
- Department of Pediatrics, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Mojtaba Lotfi
- Department of Pediatrics, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
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Reyes AP, León NY, Frost ER, Harley VR. Genetic control of typical and atypical sex development. Nat Rev Urol 2023:10.1038/s41585-023-00754-x. [PMID: 37020056 DOI: 10.1038/s41585-023-00754-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 04/07/2023]
Abstract
Sex development relies on the sex-specific action of gene networks to differentiate the bipotential gonads of the growing fetus into testis or ovaries, followed by the differentiation of internal and external genitalia depending on the presence or absence of hormones. Differences in sex development (DSD) arise from congenital alterations during any of these processes, and are classified depending on sex chromosomal constitution as sex chromosome DSD, 46,XY DSD or 46,XX DSD. Understanding the genetics and embryology of typical and atypical sex development is essential for diagnosing, treating and managing DSD. Advances have been made in understanding the genetic causes of DSD over the past 10 years, especially for 46,XY DSD. Additional information is required to better understand ovarian and female development and to identify further genetic causes of 46,XX DSD, besides congenital adrenal hyperplasia. Ongoing research is focused on the discovery of further genes related to typical and atypical sex development and, therefore, on improving diagnosis of DSD.
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Affiliation(s)
- Alejandra P Reyes
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Genetics Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Nayla Y León
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Emily R Frost
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Vincent R Harley
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.
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The Genotype-Phenotype Correlation in Human 5α-Reductase Type 2 Deficiency: Classified and Analyzed from a SRD5A2 Structural Perspective. Int J Mol Sci 2023; 24:ijms24043297. [PMID: 36834714 PMCID: PMC9966410 DOI: 10.3390/ijms24043297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
The phenotype of the 5α-reductase type 2 deficiency (5αRD2) by the SRD5A2 gene mutation varies, and although there have been many attempts, the genotype-phenotype correlation still has not yet been adequately evaluated. Recently, the crystal structure of the 5α-reductase type 2 isozyme (SRD5A2) has been determined. Therefore, the present study retrospectively evaluated the genotype-phenotype correlation from a structural perspective in 19 Korean patients with 5αRD2. Additionally, variants were classified according to structural categories, and phenotypic severity was compared with previously published data. The p.R227Q variant, which belongs to the NADPH-binding residue mutation category, exhibited a more masculine phenotype (higher external masculinization score) than other variants. Furthermore, compound heterozygous mutations with p.R227Q mitigated phenotypic severity. Similarly, other mutations in this category showed mild to moderate phenotypes. Conversely, the variants categorized as structure-destabilizing and small to bulky residue mutations showed moderate to severe phenotypes, and those categorized as catalytic site and helix-breaking mutations exhibited severe phenotypes. Therefore, the SRD5A2 structural approach suggested that a genotype-phenotype correlation does exist in 5αRD2. Furthermore, the categorization of SRD5A2 gene variants according to the SRD5A2 structure facilitates the prediction of the severity of 5αRD2 and the management and genetic counseling of patients affected by it.
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Disorders of sex development (DSD) 46.XY due to type 2 5-α reductase deficiency in three siblings: Case report from a low-resource setting. Ann Med Surg (Lond) 2022; 82:104577. [PMID: 36268297 PMCID: PMC9577524 DOI: 10.1016/j.amsu.2022.104577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/31/2022] [Accepted: 09/04/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction and Importance Disorders of Sexual Development (DSD) is a rare autosomal recessive genetic condition significantly affecting patients' lives in various aspects, particularly psychosocially. Type 2 5-α reductase is a cause of DSD 46,XY. It is rare to find multiple DSDs in the same family. Patients may present with amenorrhea and ambiguous genitalia. This case report is aimed to highlight the genetic aspects of the disease, the challenges to diagnostics and the various management options for the patients. Methods Case series of three siblings with DSD 46, XY with relevant discussion. Outcomes Three sisters, aged nineteen, seventeen, and fifteen years old came with an identical complaint of late menarche. Their physical examinations revealed elementary breast development and little axillary hair. The external genitals consisted of vulva, major and minor labia. Clitoromegaly was present with short (<5 cm) vagina. No female internal genital was found but undescended testes were palpable. Presences of testes was confirmed via ultrasound. Laboratory results showed reduced estradiol, highly increased follicle stimulating hormone (FSH), normal male testosterone levels and increased testosterone-dihydrotestosterone ratio (T/DHT >20). Karyotype was 46,XY. Diagnoses of DSD 46, XY due to type 2 5-α reductase deficiency were established. Patient 1 chose female as the gender of choice whilst patients 2 and 3 chose male. All patients are due for corrective surgery along with psychotherapy and psychoeducation. Conclusion DSD 46, XY due to type 2 5-α reductase deficiency is a rare autosomal recessive genetic disorder requiring comprehensive diagnostics and holistic management to improve patient quality of life. Disorder of sexual development (46,XY) due to type 2 5-α reductase deficiency is rare. It requires a multidisciplinary team involving a battery of tests, imaging and genetic tests, e.g. karyotyping. Informed consent and collaboration with other disciplines are pivotal for holistic management.
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González Fenández M, Antonio IED, Martín IMDLP, Martínez JS, Almaraz MCA. 5-Alpha-reductase type 2 deficiency. A new case in the Spanish population. ENDOCRINOLOGÍA, DIABETES Y NUTRICIÓN (ENGLISH ED.) 2022; 69:384-386. [PMID: 35697471 DOI: 10.1016/j.endien.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/25/2021] [Indexed: 10/18/2022]
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McGee LM, Lin-Brande M, Woods K, Seideman CA. Pubertal Suppression and Surgical Management of a Patient with 5-alpha Reductase Deficiency. Urology 2022; 165:e29-e31. [DOI: 10.1016/j.urology.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/14/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
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Han B, Zhu H, Yao H, Ren J, O'Day P, Wang H, Zhu W, Cheng T, Auchus RJ, Qiao J. Differences of adrenal-derived androgens in 5α-reductase deficiency versus androgen insensitivity syndrome. Clin Transl Sci 2021; 15:658-666. [PMID: 34755921 PMCID: PMC8932821 DOI: 10.1111/cts.13184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 11/27/2022] Open
Abstract
Steroid 5α‐reductase type 2 deficiency (5α‐RD2) and androgen insensitivity syndrome (AIS) are difficult to distinguish clinically and biochemically, and adrenal‐derived androgens have not been investigated in these conditions using modern methods. The objective of the study was to compare Chinese patients with 5α‐RD2, AIS, and healthy men. Sixteen patients with 5α‐RD2, 10 patients with AIS, and 39 healthy men were included. Serum androgen profiles were compared in these subjects using liquid chromatography/tandem mass spectrometry (LC‐MS/MS). Based on clinical features and laboratory tests, 5α‐RD2 and AIS were diagnosed and confirmed by genotyping. Dihydrotestosterone (DHT) and testosterone (T) were both significantly lower in patients with 5α‐RD2 than AIS (p < 0.0001). The T/DHT ratio was higher in 5α‐RD2 (4.5–88.6) than AIS (13.4–26.7) or healthy men (7.6–40.5). Using LC‐MS/MS, a cutoff T/DHT value of 27.3 correctly diagnosed 5α‐RD2 versus AIS with sensitivity 93.8% and specificity 100%. Among the adrenal‐derived 11‐oxygenated androgens, 11β‐hydroxyandrostenedione (11OHA4) and 11‐ketoandrostenedione (11KA4) were also lower in patients with 5α‐RD2 than those of patients with AIS. In contrast, 11β‐hydroxytestosterone (11OHT) was higher in 5α‐RD2 than AIS. Furthermore, a 11OHT/11OHA4 cutoff value of 0.048 could also distinguish 5α‐RD2 from AIS. Thus, both elevated T/DHT values above 27.3 and the unexpected 11‐oxygenated androgen profile, with a 11OHT/11OHA4 ratio greater than 0.048, distinguished 5α‐RD2 from AIS. These data suggest that the metabolism of both gonadal and adrenal‐derived androgens is altered in 5α‐RD2.
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Affiliation(s)
- Bing Han
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Zhu
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haijun Yao
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianwei Ren
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, Department of Pharmacology, the Program for Disorders of Sexual Development, University of Michigan, Ann Arbor, Michigan, USA
| | - Patrick O'Day
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, Department of Pharmacology, the Program for Disorders of Sexual Development, University of Michigan, Ann Arbor, Michigan, USA
| | - Hao Wang
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjiao Zhu
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tong Cheng
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Richard J Auchus
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, Department of Pharmacology, the Program for Disorders of Sexual Development, University of Michigan, Ann Arbor, Michigan, USA
| | - Jie Qiao
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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González Fenández M, Antonio IED, Martín IMDLP, Martínez JS, Almaraz MCA. 5-Alpha-reductase type 2 deficiency. A new case in the Spanish population. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00124-5. [PMID: 34140259 DOI: 10.1016/j.endinu.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Mikel González Fenández
- Endocrinology and Nutrition Department of University Hospital Miguel Servet, Zaragoza, Spain
| | - Isabel Esteva de Antonio
- Endocrinology and Nutrition Department, Gender Identity Unity, Regional University Hospital of Málaga, IBIMA, CIBERDEM, Málaga, Spain
| | - Idoia Martínez de la Piscina Martín
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV/EHU, CIBERER, CIBERDEM, ENDO-ERN, Plaza de Cruces 12, 48903 Barakaldo, Spain
| | | | - María Cruz Almaraz Almaraz
- Endocrinology and Nutrition Department, Gender Identity Unity, Regional University Hospital of Málaga, IBIMA, CIBERDEM, Málaga, Spain.
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Cheng T, Wang H, Han B, Zhu H, Yao HJ, Zhao SX, Zhu WJ, Zhai HL, Chen FG, Song HD, Cheng KX, Liu Y, Qiao J. Identification of three novel SRD5A2 mutations in Chinese patients with 5α-reductase 2 deficiency. Asian J Androl 2020; 21:577-581. [PMID: 31031332 PMCID: PMC6859664 DOI: 10.4103/aja.aja_113_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In this study, we investigated the genetics, clinical features, and therapeutic approach of 14 patients with 5α-reductase deficiency in China. Genotyping analysis was performed by direct sequencing of PCR products of the steroid 5α-reductase type 2 gene (SRD5A2). The 5α-reductase activities of three novel mutations were investigated by mutagenesis and an in vitro transfection assay. Most patients presented with a microphallus, variable degrees of hypospadias, and cryptorchidism. Eight of 14 patients (57.1%) were initially reared as females and changed their social gender from female to male after puberty. Nine mutations were identified in the 14 patients. p.G203S, p.Q6X, and p.R227Q were the most prevalent mutations. Three mutations (p.K35N, p.H162P, and p.Y136X) have not been reported previously. The nonsense mutation p.Y136X abolished enzymatic activity, whereas p.K35N and p.H162P retained partial enzymatic activity. Topical administration of dihydrotestosterone during infancy or early childhood combined with hypospadia repair surgery had good therapeutic results. In conclusion, we expand the mutation profile of SRD5A2 in the Chinese population. A rational clinical approach to this disorder requires early and accurate diagnosis, especially genetic diagnosis.
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Affiliation(s)
- Tong Cheng
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Hao Wang
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Bing Han
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Hui Zhu
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Hai-Jun Yao
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Shuang-Xia Zhao
- Central Laboratory, Clinical Research Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Wen-Jiao Zhu
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Hua-Ling Zhai
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Fu-Guo Chen
- Department of Plastic Surgery, Research Center of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Huai-Dong Song
- Central Laboratory, Clinical Research Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Kai-Xiang Cheng
- Department of Plastic Surgery, Research Center of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yang Liu
- Department of Plastic Surgery, Research Center of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Jie Qiao
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Cocchetti C, Ristori J, Mazzoli F, Prunas A, Bertelloni S, Magini A, Vignozzi L, Maggi M, Fisher AD. 5α-Reductase-2 deficiency: is gender assignment recommended in infancy? Two case-reports and review of the literature. J Endocrinol Invest 2020; 43:1131-1136. [PMID: 32036582 DOI: 10.1007/s40618-020-01193-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/30/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Gender assignment represents one of the most controversial aspects of the clinical management of individuals with Differences of Sex Development, including 5α-Reductase-2 deficiency (SRD5A2). Given the predominant female appearance of external genitalia in individuals with SRD5A2 deficiency, most of them were assigned to the female sex at birth. However, in the last years the high rate of gender role shift from female to male led to recommend a male gender assignment. METHODS We here describe two cases of subjects with SRD5A2 deficiency assigned as females at birth, reporting their clinical histories and psychometric evaluations (Body Uneasiness Test, Utrecht Gender Dysphoria Scale, Bem Sex-Role Inventory, Female Sexual Distress Scale Revised, visual analogue scale for gender identity and sexual orientation) performed at the time of referral at the Florence Gender Clinic. RESULTS Both patients underwent early surgical interventions without being included in the decision-making process. They had to conform to a binary feminine gender role because of social/familiar pressure, with a significant impact on their psychological well-being. Psychometric evaluations identified clinically significant body uneasiness and gender incongruence in both subjects. No sexually related distress and undifferentiated gender role resulted in the first subject and sexually related distress and androgynous gender role resulted in the second subject. CONCLUSIONS The reported cases suggest the possibility to consider a new approach for gender assignment in these individuals, involving them directly in the decision-making process and allowing them to explore their gender identity, also with the help of GnRH analogues to delay pubertal modifications.
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Affiliation(s)
- C Cocchetti
- Andrology, Women's Endocrinology and Gender Incongruence Unit, University of Florence, Florence, Italy
| | - J Ristori
- Andrology, Women's Endocrinology and Gender Incongruence Unit, University of Florence, Florence, Italy
| | - F Mazzoli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, University of Florence, Florence, Italy
| | - A Prunas
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - S Bertelloni
- Pediatric Division, Department of Obstetrics, Gynecology and Pediatrics, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Magini
- Andrology, Women's Endocrinology and Gender Incongruence Unit, University of Florence, Florence, Italy
| | - L Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, University of Florence, Florence, Italy
| | - M Maggi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - A D Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, University of Florence, Florence, Italy.
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Fan L, Song Y, Polak M, Li L, Ren X, Zhang B, Wu D, Gong C. Clinical characteristics and genotype-phenotype correlations of 130 Chinese children in a high-homogeneity single-center cohort with 5α-reductase 2 deficiency. Mol Genet Genomic Med 2020; 8:e1431. [PMID: 32713132 PMCID: PMC7549558 DOI: 10.1002/mgg3.1431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/13/2020] [Accepted: 07/10/2020] [Indexed: 11/11/2022] Open
Abstract
Background Patients with steroid 5α‐reductase 2 deficiency (5α‐RD) caused by SRD5A2 (OMIM #607306) variants present variable genotypes and phenotypes. The genotype‐phenotype correlations remain unclear. Methods We investigated genotype‐phenotype correlations of SRD5A2 variants in a large Chinese single‐center cohort. Phenotypes were categorized using the external masculinization score (EMS), urethral meatus and gonad position, and penile length‐standard deviation score. Results Of the 130 included patients, 113 had hypospadias, and 17 had a normal urethral meatus position. Testosterone/dihydrotestosterone (T/DHT) values were not significantly associated with phenotypic severity (p = 0.539–0.989). Of the 31 SRD5A2 variants, including 10 novel variants, p.R227Q was the most prevalent (39.62%), followed by p.Q6* (16.92%), p.R246Q (13.46%), and p.G203S (10.38%). Compared to biallelic missense mutations, biallelic nonsense mutations were associated with a lower EMS and urethral meatus score (p = 0.009 and p = 0.024, respectively). Patients homozygous for p.R227Q exhibited mild and variable phenotypes, while those homozygous for p.Q6*, p.R246Q, or p.G203S showed consistently severe phenotypes. The phenotypes were variable and milder in patients with compound heterozygosity for p.R227Q and these mutations. Conclusion T/DHT does not predict phenotype severity. The most prevalent SRD5A2 variant in Han Chinese is p.R227Q, which is associated with milder phenotypes and greater phenotypic variability. SRD5A2 variants may significantly influence phenotypic variation.
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Affiliation(s)
- Lijun Fan
- Department of Endocrinology, Genetics, Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Beijing Key Laboratory for Genetics of Birth Defects, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yanning Song
- Department of Endocrinology, Genetics, Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Beijing Key Laboratory for Genetics of Birth Defects, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Michel Polak
- Service d'endocrinologie, gynécologie et diabétologiepédiatriques, Hôpitaluniversitaire Necker Enfants Malades, université de Paris, IMAGINE institute, Paris, France
| | - Lele Li
- Department of Endocrinology, Genetics, Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Beijing Key Laboratory for Genetics of Birth Defects, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoya Ren
- Department of Endocrinology, Genetics, Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Beijing Key Laboratory for Genetics of Birth Defects, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Beibei Zhang
- Department of Endocrinology, Genetics, Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Beijing Key Laboratory for Genetics of Birth Defects, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Di Wu
- Department of Endocrinology, Genetics, Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Beijing Key Laboratory for Genetics of Birth Defects, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chunxiu Gong
- Department of Endocrinology, Genetics, Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.,Beijing Key Laboratory for Genetics of Birth Defects, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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14
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Genetic Analysis of 25 Patients with 5 α-Reductase Deficiency in Chinese Population. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1789514. [PMID: 32596280 PMCID: PMC7301183 DOI: 10.1155/2020/1789514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/06/2020] [Accepted: 03/02/2020] [Indexed: 12/13/2022]
Abstract
Background A deficiency in steroid 5α-reductase type 2 is an autosomal recessive disorder. Affected individuals manifested ambiguous genitalia, which is caused by decreased dihydrotestosterone (DHT) synthesis in the fetus. Methods We analyzed 25 patients with 5α-reductase deficiency in China. Seventeen of the 25 patients (68%) were initially raised as females. Sixteen patients changed their social gender from female to male after puberty. Results Eighteen mutations were identified in these patients. p.Gly203Ser and p.Gln6∗ were found to be the most prevalent mutations. On the basis of the genotype of these patients, we divided them into different groups. There was no significant difference in hormone levels and external masculinization score (EMS) in patients with or without these prevalent mutations. Twelve common single-nucleotide polymorphisms (SNPs) near the p.Gln6∗ mutation were chosen for haplotype analysis. Three haplotypes were observed in 6 patients who had the p.Gln6∗ mutation (12 alleles). Conclusion We analyzed mutations of the SRD5A2 gene in Chinese patients with 5α-reductase deficiency. Although hotspot mutations exist, no founder effect of prevalent mutations in the SRD5A2 gene was detected in the Chinese population.
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15
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Storbeck KH, Schiffer L, Baranowski ES, Chortis V, Prete A, Barnard L, Gilligan LC, Taylor AE, Idkowiak J, Arlt W, Shackleton CHL. Steroid Metabolome Analysis in Disorders of Adrenal Steroid Biosynthesis and Metabolism. Endocr Rev 2019; 40:1605-1625. [PMID: 31294783 PMCID: PMC6858476 DOI: 10.1210/er.2018-00262] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 06/04/2019] [Indexed: 01/01/2023]
Abstract
Steroid biosynthesis and metabolism are reflected by the serum steroid metabolome and, in even more detail, by the 24-hour urine steroid metabolome, which can provide unique insights into alterations of steroid flow and output indicative of underlying conditions. Mass spectrometry-based steroid metabolome profiling has allowed for the identification of unique multisteroid signatures associated with disorders of steroid biosynthesis and metabolism that can be used for personalized approaches to diagnosis, differential diagnosis, and prognostic prediction. Additionally, steroid metabolome analysis has been used successfully as a discovery tool, for the identification of novel steroidogenic disorders and pathways as well as revealing insights into the pathophysiology of adrenal disease. Increased availability and technological advances in mass spectrometry-based methodologies have refocused attention on steroid metabolome profiling and facilitated the development of high-throughput steroid profiling methods soon to reach clinical practice. Furthermore, steroid metabolomics, the combination of mass spectrometry-based steroid analysis with machine learning-based approaches, has facilitated the development of powerful customized diagnostic approaches. In this review, we provide a comprehensive up-to-date overview of the utility of steroid metabolome analysis for the diagnosis and management of inborn disorders of steroidogenesis and autonomous adrenal steroid excess in the context of adrenal tumors.
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Affiliation(s)
- Karl-Heinz Storbeck
- Department of Biochemistry, Stellenbosch University, Stellenbosch, South Africa
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Lina Schiffer
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Elizabeth S Baranowski
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
- Department of Paediatric Endocrinology and Diabetes, Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Vasileios Chortis
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Alessandro Prete
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Lise Barnard
- Department of Biochemistry, Stellenbosch University, Stellenbosch, South Africa
| | - Lorna C Gilligan
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Angela E Taylor
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Jan Idkowiak
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
- Department of Paediatric Endocrinology and Diabetes, Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | - Cedric H L Shackleton
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- UCSF Benioff Children’s Hospital Oakland Research Institute, Oakland, California
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16
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Avendaño A, González-Coira M, Paradisi I, Rojas A, Da Silva G, Gómez-Pérez R, Ceballos JO. 5α-Reductase type 2 deficiency in families from an isolated Andean population in Venezuela. Ann Hum Genet 2019; 84:151-160. [PMID: 31613402 DOI: 10.1111/ahg.12358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/14/2019] [Accepted: 09/17/2019] [Indexed: 12/29/2022]
Abstract
5α-Reductase type 2 deficiency causes a 46,XY disorder of sex development (DSD) characterized by ambiguous external genitalia, rudimentary prostate, and normal internal genitalia. The disease prevalence worldwide is low, but in a small and isolated village of the Venezuelan Andes, a higher incidence has been found. DNA analysis of the SRD5A2 gene was performed in three inbred affected individuals clinically diagnosed with DSD. The entire coding regions, the p.L89V polymorphism (rs523349) and five intragenic SNPs (rs2300702, rs2268797, rs2268796, rs4952220, rs12470196) used to construct haplotypes were analyzed by Sanger sequencing. To assess the probable ethnic origin of the mutation in this geographic isolate, a population structure analysis was performed. Homozygosis for the p.N193S mutation was found in all patients, with a mutation carrier frequency of 1:80 chromosomes (0.0125) in the geographic focus, suggesting a founder phenomenon. The results of the population structure analysis suggested a mutation origin closer to the Spanish populations, according to the clusters grouping. The genotype-phenotype correlation in the patients was not absolute, being hypospadias and cryptorchidism the main traits that differentiate affected individuals.
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Affiliation(s)
- Andrea Avendaño
- Medical Genetics Unit, Medicine Faculty, Los Andes University, Mérida, Venezuela
| | | | - Irene Paradisi
- Venezuelan Institute for Scientific Research (IVIC), Laboratory of Human Genetics, Caracas, Venezuela
| | - Ascanio Rojas
- National Center for Scientific Calculation (CeCalcULA), Los Andes University, Mérida, Venezuela
| | - Gloria Da Silva
- Medical Genetics Unit, Medicine Faculty, Los Andes University, Mérida, Venezuela
| | - Roald Gómez-Pérez
- Endocrinology Service, Los Andes University Hospital (I.A.H.U.L.A.), Mérida, Venezuela
| | - Jesús Osuna Ceballos
- Andrology Laboratory, Los Andes University, Electronic Microscopic Center, Mérida, Venezuela
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17
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Yoon JY, Cheon CK. Evaluation and management of amenorrhea related to congenital sex hormonal disorders. Ann Pediatr Endocrinol Metab 2019; 24:149-157. [PMID: 31607107 PMCID: PMC6790874 DOI: 10.6065/apem.2019.24.3.149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/24/2019] [Indexed: 01/13/2023] Open
Abstract
Primary amenorrhea is a symptom with a substantial list of underlying etiologies which presents in adolescence, although some conditions are diagnosed in childhood. Primary amenorrhea is defined as not having menarche until 15 years of age (or 13 years with secondary sex characteristics). Various etiologies of primary amenorrhea include outflow tract obstructions, gonadal dysgenesis, abnormalities of the central nervous system, various endocrine diseases, chronic illnesses, psychologic problems, and constitutional delay of puberty. The management of primary amenorrhea may vary considerably depending on the patient and the specific diagnosis. In this article, the various causes, evaluation, and management of primary amenorrhea are reviewed with special emphasis on congenital sex hormonal disorders.
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Affiliation(s)
- Ju Young Yoon
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
| | - Chong Kun Cheon
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea,Address for correspondence: Chong Kun Cheon, MD, PhD Division of Pediatric Endocrinology, Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Geumo-ro 20, Yangsan 50612, Korea Tel: +82-55-360-3158 Fax: +82-55-360-2181 E-mail:
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18
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Abacı A, Çatlı G, Kırbıyık Ö, Şahin NM, Abalı ZY, Ünal E, Şıklar Z, Mengen E, Özen S, Güran T, Kara C, Yıldız M, Eren E, Nalbantoğlu Ö, Güven A, Çayır A, Akbaş ED, Kor Y, Çürek Y, Aycan Z, Baş F, Darcan Ş, Berberoğlu M. Genotype-phenotype correlation, gonadal malignancy risk, gender preference, and testosterone/dihydrotestosterone ratio in steroid 5-alpha-reductase type 2 deficiency: a multicenter study from Turkey. J Endocrinol Invest 2019; 42:453-470. [PMID: 30132287 DOI: 10.1007/s40618-018-0940-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 08/06/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Studies regarding genetic and clinical characteristics, gender preference, and gonadal malignancy rates for steroid 5-alpha-reductase type 2 deficiency (5α-RD2) are limited and they were conducted on small number of patients. OBJECTIVE To present genotype-phenotype correlation, gonadal malignancy risk, gender preference, and diagnostic sensitivity of serum testosterone/dihydrotestosterone (T/DHT) ratio in patients with 5α-RD2. MATERIALS AND METHODS Patients with variations in the SRD5A2 gene were included in the study. Demographic characteristics, phenotype, gender assignment, hormonal tests, molecular genetic data, and presence of gonadal malignancy were evaluated. RESULTS A total of 85 patients were included in the study. Abnormality of the external genitalia was the most dominant phenotype (92.9%). Gender assignment was male in 58.8% and female in 29.4% of the patients, while it was uncertain for 11.8%. Fourteen patients underwent bilateral gonadectomy, and no gonadal malignancy was detected. The most frequent pathogenic variants were p.Ala65Pro (30.6%), p.Leu55Gln (16.5%), and p.Gly196Ser (15.3%). The p.Ala65Pro and p.Leu55Gln showed more undervirilization than the p.Gly196Ser. The diagnostic sensitivity of stimulated T/DHT ratio was higher than baseline serum T/DHT ratio, even in pubertal patients. The cut-off values yielding the best sensitivity for stimulated T/DHT ratio were ≥ 8.5 for minipuberty, ≥ 10 for prepuberty, and ≥ 17 for puberty. CONCLUSION There is no significant genotype-phenotype correlation in 5α-RD2. Gonadal malignancy risk seems to be low. If genetic analysis is not available at the time of diagnosis, stimulated T/DHT ratio can be useful, especially if different cut-off values are utilized in accordance with the pubertal status.
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Affiliation(s)
- A Abacı
- Department of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Balcova, 35340, Izmir, Turkey.
| | - G Çatlı
- Department of Pediatric Endocrinology, Faculty of Medicine, İzmir Katip Çelebi University, Izmir, Turkey
| | - Ö Kırbıyık
- Division of Genetics, Tepecik Training and Research Hospital, Sağlık Bilimleri University, Izmir, Turkey
| | - N M Şahin
- Department of Pediatric Endocrinology, Faculty of Medicine and Dr Sami Ulus Woman Health and Children Research Hospital, Yıldırım Beyazıt University, Ankara, Turkey
| | - Z Y Abalı
- Department of Pediatric Endocrinology, Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - E Ünal
- Department of Pediatric Endocrinology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Z Şıklar
- Department of Pediatric Endocrinology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - E Mengen
- Department of Pediatric Endocrinology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - S Özen
- Department of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - T Güran
- Department of Pediatric Endocrinology, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - C Kara
- Department of Pediatric Endocrinology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - M Yıldız
- Division of Pediatric Endocrinology, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - E Eren
- Department of Pediatric Endocrinology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Ö Nalbantoğlu
- Division of Pediatric Endocrinology, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - A Güven
- Department of Pediatric Endocrinology, Göztepe Training and Research Hospital, İstanbul, Turkey
- Department of Pediatric Endocrinology, Faculty of Medicine, Amasya University, Amasya, Turkey
| | - A Çayır
- Division of Pediatric Endocrinology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - E D Akbaş
- Department of Pediatric Endocrinology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Y Kor
- Department of Pediatric Endocrinology, Numune Training and Research Hospital, Sağlık Bilimleri University, Adana, Turkey
| | - Y Çürek
- Department of Pediatric Endocrinology, Sağlık Bilimleri University Antalya Training and Research Hospital, Antalya, Turkey
| | - Z Aycan
- Department of Pediatric Endocrinology, Faculty of Medicine and Dr Sami Ulus Woman Health and Children Research Hospital, Yıldırım Beyazıt University, Ankara, Turkey
| | - F Baş
- Department of Pediatric Endocrinology, Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Ş Darcan
- Department of Pediatric Endocrinology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - M Berberoğlu
- Department of Pediatric Endocrinology, Faculty of Medicine, Ankara University, Ankara, Turkey
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19
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Deeb A, Khamis M, Sayed SA, Magdy Omar O, Odeh R, Ladjouze A, Ameri EA. Sex assignment practice in disorders of sexual differentiation: survey results from paediatric endocrinologists in the Arab region. J Pediatr Endocrinol Metab 2019; 32:75-82. [PMID: 30864373 DOI: 10.1515/jpem-2018-0323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/16/2018] [Indexed: 11/15/2022]
Abstract
Background Sex assignment is a major issue in disorders of sexual differentiation (DSD). Not all conditions of DSD have clear recommendations on assignment and timing of surgery. Reports about sex assignment practice and the influence of culture and religion in the Arab region are scarce. Methods A survey questionnaire was distributed to participants in a paediatric endocrinology conference. Four DSD cases were presented. Participants were asked to fill in their answers on sex assignment choice, reasons for the particular assignment, strength of own recommendation and timing of surgery based on their practice. The cases presented were severely virilised XX congenital adrenal hyperplasia (CAH), complete androgen insensitivity syndrome (CAIS), severely undervirilised 5α reductase deficiency (5α RD) and XX ovotesticular case. Results Eighty-five endocrinologists participated in the study. Eighty (97.5%) chose a female sex to assign for the XX CAH. For the CAIS, 64 (78%) chose a female sex. Seventy-one (86.5%) voted for a male sex for the XY case of 5α RD. Forty-seven (57%) and 35 (43%) chose a female and a male sex for the ovotesticular case, respectively. The majority indicated that their advice for sex assignment is based on strong recommendations for the CAH, CAIS and 5α RD patients but they were open to the parents' cultural and religious beliefs in their decision of the assignment for the ovotesticular case. Conclusions Practice in the Arab region appears to be in line with the international guidelines in the majority of DSD sex assignment and timing of surgery issues. However, culture and religious beliefs influence the practice in certain circumstances.
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Affiliation(s)
- Asma Deeb
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, UAE
| | - Maryam Khamis
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, UAE
| | - Shayma Al Sayed
- Paediatric Endocrinology and Diabetology Department, Alexandria University, Alexandria, Egypt
| | - Omneya Magdy Omar
- Pediatric Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rasha Odeh
- Department of Paediatrics, School of Medicine, University of Jordan, Amman, Jordan
| | - Asmahane Ladjouze
- Paediatric Department, Bab el Oued Teaching Hospital, Algiers, Algeria
| | - Elham Al Ameri
- Pediatric Endocrinology Department, Al Qassimi Hospital, Sharjah, UAE
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20
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O'Hanlan KA, Gordon JC, Sullivan MW. Biological origins of sexual orientation and gender identity: Impact on health. Gynecol Oncol 2018; 149:33-42. [PMID: 29605047 DOI: 10.1016/j.ygyno.2017.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/30/2017] [Accepted: 11/07/2017] [Indexed: 01/19/2023]
Abstract
Gynecologic Oncologists are sometimes consulted to care for patients who present with diverse gender identities or sexual orientations. Clinicians can create more helpful relationships with their patients if they understand the etiologies of these diverse expressions of sexual humanity. Multidisciplinary evidence reveals that a sexually dimorphic spectrum of somatic and neurologic anatomy, traits and abilities, including sexual orientation and gender identity, are conferred together during the first half of pregnancy due to genetics, epigenetics and the diversity of timing and function of sex chromosomes, sex-determining protein secretion, gonadal hormone secretion, receptor levels, adrenal function, maternally ingested dietary hormones, fetal health, and many other factors. Multiple layers of evidence confirm that sexual orientation and gender identity are as biological, innate and immutable as the other traits conferred during that critical time in gestation. Negative social responses to diverse orientations or gender identities have caused marginalization of these individuals with resultant alienation from medical care, reduced self-care and reduced access to medical care. The increased risks for many diseases, including gynecologic cancers are reviewed. Gynecologic Oncologists can potentially create more effective healthcare relationships with their patients if they have this information.
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Affiliation(s)
- Katherine A O'Hanlan
- Laparoscopic Institute for Gynecology and Oncology (LIGO), 4370 Alpine Rd. Suite 104, Portola Valley, CA 94028, United States.
| | - Jennifer C Gordon
- University of Tennessee Health Sciences Center, Memphis, TN, United States.
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21
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Jia W, Zheng D, Zhang L, Li C, Zhang X, Wang F, Guan Q, Fang L, Zhao J, Xu C. Clinical and molecular characterization of 5α-reductase type 2 deficiency due to mutations (p.Q6X, p.R246Q) in SRD5A2 gene. Endocr J 2018; 65:645-655. [PMID: 29643321 DOI: 10.1507/endocrj.ej17-0542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Early diagnosis and optimal management for steroid 5α-reductase type 2 deficiency (5α-RD2) patients are major challenges for clinicians and mutation analysis for the 5α-reductase type 2 (SRD5A2) gene is the golden standard for the diagnosis of the disease. In silico analysis of this enzyme has not been reported due to the lack of appropriate model. Moreover, the histological and pathological changes of the gonads are largely unknown. In the present study, a 5α-RD2 patient born with abnormal external genitalia was studied and mutation analysis for SRD5A2 gene was conducted. Moreover, we constructed the homology modeling of 5α-reductase using SWISS-MODEL, followed by the molecular docking study. Furthermore, immunohistochemical staining of Ki67 for the testes tissue was conducted to investigate the potential pathological characteristics. The patient had male (46, XY) chromosomes but presented female characteristics, and the mutation analysis identified a heterozygotes mutation (p.Q6X, p.R246Q) in SRD5A2 gene. In silico analysis elucidated the potential effect of the mutation on enzyme activity. Immunohistochemical staining for the excised testes showed that 30%-50% of the germ cells were Ki67 positive, which indicated the early neoplastic potential. In conclusion, we analyzed the genotype-phenotype correlations of 5α-RD2 caused by a heterozygotes mutation (p.Q6X, p.R246Q). Importantly, we conducted the homology modeling and molecular docking for the first time, which provided a homology model for further investigations. Immunohistochemical results suggested gonadectomy or testis descent should be performed early for 5α-RD2 patient, as delayed treatment would have maintained the testes in a tumorigenic condition.
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Affiliation(s)
- Wenyu Jia
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China
| | - Dongmei Zheng
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China
| | - Liya Zhang
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China
| | - Changzhong Li
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China
| | - Xu Zhang
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China
| | - Fei Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China
| | - Qingbo Guan
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China
| | - Li Fang
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China
| | - Jiajun Zhao
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China
| | - Chao Xu
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China
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Heeley JM, Hollander AS, Austin PF, Merritt DF, Wesevich VG, Amarillo IE. Risk association of congenital anomalies in patients with ambiguous genitalia: A 22-year single-center experience. J Pediatr Urol 2018; 14:153.e1-153.e7. [PMID: 29157626 DOI: 10.1016/j.jpurol.2017.09.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 09/22/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ambiguous genitalia refers to a form of differences of sex development (DSD) wherein the appearance of the external genitalia is atypical. This rare condition presents challenges in decision-making and clinical management. Review of historical data may reveal areas for clinical research to improve care for patients with ambiguous genitalia. OBJECTIVE This chart review was performed to identify patients with ambiguous genitalia, and to classify them as having 46,XX DSD, 46,XY DSD, or sex chromosome DSD. Within these categories, we looked at establishment of specific diagnoses, type and frequency of other congenital anomalies and neoplasms, and gender assignment, as well as incidence of gender reassignment and transition. METHODS We performed a retrospective chart review of patients diagnosed with DSD conditions from 1995 to 2016 using ICD9 codes. For the purpose of this study, review was limited to individuals assessed to have neonatal "ambiguous genitalia" or "indeterminate sex." RESULTS Review identified 128 patients evaluated for ambiguous genitalia from 22 years of experience (Figure). Approximately half of these (53%) had 46,XY karyotype, 35% had 46,XX, and the remaining 12% had sex chromosome aberrations. Diagnostic rate for 46,XX DSD was higher at 64%, all of which were congenital adrenal hyperplasia, while diagnostic rate for 46,XY DSD was 11.7% for a molecularly confirmed diagnosis and 24% if clinical diagnoses were included. The most common anomalies included cardiac anomalies in 28/128 (22%), skeletal anomalies in 19/128 (15%), and failure to thrive or growth problems in 19/128 (15%). Additional congenital anomalies were found in 53 out of 128 patients (41%). There were three reported neoplasms in this group: gonadoblastoma, hepatoblastoma, and myelodysplastic syndrome with monosomy 7. Gender assignment was consistent with chromosomes in approximately 90% of XX and XY patients. There were three recorded gender reassignments or transitions. DISCUSSION Diagnostic rate for ambiguous genitalia is low, especially in 46,XY DSD. Most neonates were assigned gender consistent with their chromosomes. Given the high rate of associated anomalies, screening for cardiac or other anomalies in patients with ambiguous genitalia may be beneficial. CONCLUSION Patients with ambiguous genitalia often have additional congenital anomalies. Establishment of a specific diagnosis is uncommon in 46,XY patients. A few patients have gender reassignment outside of the newborn period. Ongoing collection of clinical data on this population may reveal new information regarding long-term health, quality of life, and establishment of more diagnoses with improved molecular techniques.
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Affiliation(s)
- Jennifer M Heeley
- Division of Genetics and Genomics, Department of Pediatrics, Washington University School of Medicine in St. Louis, St Louis, MO, USA
| | - Abby S Hollander
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Washington University School of Medicine in St. Louis, St Louis, MO, USA
| | - Paul F Austin
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, St Louis, MO, USA
| | - Diane F Merritt
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St Louis, MO, USA
| | | | - Ina E Amarillo
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St Louis, MO, USA.
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Chauhan V, Dada R, Jain V. Retracted: Aetiology and clinical profile of children with 46, XY differences of sex development at an Indian referral centre. Andrologia 2017; 49:e12663. [PMID: 27501740 DOI: 10.1111/and.12663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2016] [Indexed: 12/01/2022] Open
Abstract
Retraction: 'Aetiology and clinical profile of children with 46, XY differences of sex development at an Indian referral centre' by Vasundhera Chauhan, Rima Dada, Vandana Jain The above article, published online on 8 August 2016 in Wiley Online Library (http://wileyonlinelibrary.com), has been retracted by agreement between the authors, the Journal Editors-in-Chief, Wolf-Bernhard Schill and Ralf Henkel, and Blackwell Verlag GmbH. The retraction has been agreed as the result of an unresolved dispute between the first author and a colleague research fellow due to the inclusion of data from patients who were simultaneously enrolled in two studies being conducted separately by the two parties. Reference Chauhan, V., Dada, R. and Jain, V. (2016), Aetiology and clinical profile of children with 46, XY differences of sex development at an Indian referral centre. Andrologia. doi:10.1111/and.12663.
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Affiliation(s)
- V Chauhan
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - R Dada
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - V Jain
- Division of Pediatric Endocrinology, Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
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24
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Fisher AD, Ristori J, Fanni E, Castellini G, Forti G, Maggi M. Gender identity, gender assignment and reassignment in individuals with disorders of sex development: a major of dilemma. J Endocrinol Invest 2016; 39:1207-1224. [PMID: 27287420 DOI: 10.1007/s40618-016-0482-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Disorders of Sex Development (DSD) are a wide range of congenital conditions characterized by an incongruence of components involved in sexual differentiation, including gender psychosexual development. The management of such disorders is complex, and one of the most crucial decision is represented by gender assignment. In fact, the primary goal in DSD is to have a gender assignment consistent with the underlying gender identity in order to prevent the distress related to a forthcoming Gender Dysphoria. Historically, gender assignment was based essentially on surgical outcomes, assuming the neutrality of gender identity at birth. This policy has been challenged in the past decade refocusing on the importance of prenatal and postnatal hormonal and genetic influences on psychosexual development. AIMS (1) to update the main psychological and medical issues that surround DSD, in particular regarding gender identity and gender assignment; (2) to report specific clinical recommendations according to the different diagnosis. METHODS A systematic search of published evidence was performed using Medline (from 1972 to March 2016). Review of the relevant literature and recommendations was based on authors' expertise. RESULTS A review of gender identity and assignment in DSD is provided as well as clinical recommendations for the management of individuals with DSD. CONCLUSIONS Given the complexity of this management, DSD individuals and their families need to be supported by a specialized multidisciplinary team, which has been universally recognized as the best practice for intersexual conditions. In case of juvenile GD in DSD, the prescription of gonadotropin-releasing hormone analogues, following the World Professional Association for Transgender Health and the Endocrine Society guidelines, should be considered. It should always be taken into account that every DSD person is unique and has to be treated with individualized care. In this perspective, international registries are crucial to improve the understanding of these challenging conditions and clinical practice, in providing a better prediction of gender identity.
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Affiliation(s)
- A D Fisher
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - J Ristori
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - E Fanni
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - G Castellini
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
- Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - G Forti
- Endocrine Unit, "Center for Research, Transfer and High Education on Chronic, Inflammatory, Degenerative and Neoplastic Disorders for the Development of Novel Therapies" (DENOThe), Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Careggi Hospital, Florence, Italy
| | - M Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
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Mouriquand PDE, Gorduza DB, Gay CL, Meyer-Bahlburg HFL, Baker L, Baskin LS, Bouvattier C, Braga LH, Caldamone AC, Duranteau L, El Ghoneimi A, Hensle TW, Hoebeke P, Kaefer M, Kalfa N, Kolon TF, Manzoni G, Mure PY, Nordenskjöld A, Pippi Salle JL, Poppas DP, Ransley PG, Rink RC, Rodrigo R, Sann L, Schober J, Sibai H, Wisniewski A, Wolffenbuttel KP, Lee P. Surgery in disorders of sex development (DSD) with a gender issue: If (why), when, and how? J Pediatr Urol 2016; 12:139-49. [PMID: 27132944 DOI: 10.1016/j.jpurol.2016.04.001] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/25/2016] [Accepted: 04/04/2016] [Indexed: 01/25/2023]
Abstract
Ten years after the consensus meeting on disorders of sex development (DSD), genital surgery continues to raise questions and criticisms concerning its indications, its technical aspects, timing and evaluation. This standpoint details each distinct situation and its possible management in 5 main groups of DSD patients with atypical genitalia: the 46,XX DSD group (congenital adrenal hyperplasia); the heterogeneous 46,XY DSD group (gonadal dysgenesis, disorders of steroidogenesis, target tissues impairments …); gonosomic mosaicisms (45,X/46,XY patients); ovo-testicular DSD; and "non-hormonal/non chromosomal" DSD. Questions are summarized for each DSD group with the support of literature and the feed-back of several world experts. Given the complexity and heterogeneity of presentation there is no consensus regarding the indications, the timing, the procedure nor the evaluation of outcome of DSD surgery. There are, however, some issues on which most experts would agree: 1) The need for identifying centres of expertise with a multidisciplinary approach; 2) A conservative management of the gonads in complete androgen insensitivity syndrome at least until puberty although some studies expressed concerns about the heightened tumour risk in this group; 3) To avoid vaginal dilatation in children after surgical reconstruction; 4) To keep asymptomatic mullerian remnants during childhood; 5) To remove confirmed streak gonads when Y material is present; 6) It is likely that 46,XY cloacal exstrophy, aphallia and severe micropenis would do best raised as male although this is based on limited outcome data. There is general acknowledgement among experts that timing, the choice of the individual and irreversibility of surgical procedures are sources of concerns. There is, however, little evidence provided regarding the impact of non-treated DSD during childhood for the individual development, the parents, society and the risk of stigmatization. The low level of evidence should lead to design collaborative prospective studies involving all parties and using consensual protocols of evaluation.
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Affiliation(s)
- Pierre D E Mouriquand
- Department of Paediatric Urology/Paediatric Surgery, Université Claude-Bernard, Hospices Civils de Lyon, Lyon, France; Centre National de Référence Maladies Rares sur les Anomalies Congénitales du Développement Génito-Sexuel, Lyon, France.
| | - Daniela Brindusa Gorduza
- Department of Paediatric Urology/Paediatric Surgery, Université Claude-Bernard, Hospices Civils de Lyon, Lyon, France; Centre National de Référence Maladies Rares sur les Anomalies Congénitales du Développement Génito-Sexuel, Lyon, France
| | - Claire-Lise Gay
- Department of Paediatric Urology/Paediatric Surgery, Université Claude-Bernard, Hospices Civils de Lyon, Lyon, France; Centre National de Référence Maladies Rares sur les Anomalies Congénitales du Développement Génito-Sexuel, Lyon, France
| | - Heino F L Meyer-Bahlburg
- NYS Psychiatric Institute, New York, NY, USA; College of Physicians & Surgeons of Columbia University, New York City, NY, USA
| | - Linda Baker
- Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Laurence S Baskin
- Pediatric Urology, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Claire Bouvattier
- Service d'Endocrinologie de l'enfant, GHU Paris-Sud, Hôpital de Bicêtre, Paris, France; Centre National de Référence Maladies Rares sur les Anomalies Congénitales du Développement Génito-Sexuel, Paris, France
| | - Luis H Braga
- Division of Urology, Department of Surgery, McMaster University, Toronto, Canada
| | - Anthony C Caldamone
- Pediatric Urology, Hasbro Children's Hospital, Providence, RI, USA; Surgery (Urology) and Pediatrics, Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Lise Duranteau
- Centre National de Référence Maladies Rares sur les Anomalies Congénitales du Développement Génito-Sexuel, Paris, France; Adolescent Gynaecology, Hôpitaux Universitaires Paris Sud (Bicêtre), Paris, France
| | - Alaa El Ghoneimi
- Pediatric Surgery and Urology, University Hospital Robert Debré, APHP, University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Terry W Hensle
- College of Physicians & Surgeons of Columbia University, New York City, NY, USA
| | - Piet Hoebeke
- Urology, Ghent University Hospital, Gent, Belgium
| | - Martin Kaefer
- Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicolas Kalfa
- Service de Chirurgie Viscérale et Urologique Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France
| | - Thomas F Kolon
- Pediatric Urology, Children's Hospital of Philadelphia, PA, USA; Perelman School of Medicine at University of Pennsylvania, PA, USA
| | - Gianantonio Manzoni
- Pediatric Urology, Fondazione IRCCS CaGranda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Pierre-Yves Mure
- Department of Paediatric Urology/Paediatric Surgery, Université Claude-Bernard, Hospices Civils de Lyon, Lyon, France; Centre National de Référence Maladies Rares sur les Anomalies Congénitales du Développement Génito-Sexuel, Lyon, France
| | - Agneta Nordenskjöld
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - J L Pippi Salle
- Department of Surgery, Sidra Medical and Research Center, Doha, Qatar
| | - Dix Phillip Poppas
- Komansky Center for Children's Health, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Philip G Ransley
- Great Ormond Street Hospital, Institute of Child Health, London, UK
| | - Richard C Rink
- Service de Chirurgie Viscérale et Urologique Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France
| | - Romao Rodrigo
- Department of Surgery, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada; Department of Urology, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Léon Sann
- Conseil d'éthique pédiatrique, Centre Hospitalo-Universitaire de Lyon, France
| | | | - Hisham Sibai
- Paediatric Surgery, University of Casablanca, Morocco
| | | | - Katja P Wolffenbuttel
- Department of Urology and Pediatric Urology, Erasmus MC Sophia Children's Hospital, Rotterdam
| | - Peter Lee
- Penn State Hershey Pediatric Endocrinology, PA, USA
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Eren E, Edgünlü T, Asut E, Karakaş Çelik S. Homozygous Ala65Pro Mutation with V89L Polymorphism in SRD5A2 Deficiency. J Clin Res Pediatr Endocrinol 2016; 8:218-23. [PMID: 26761946 PMCID: PMC5096479 DOI: 10.4274/jcrpe.2495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Deficiency of steroid 5-alpha reductase type 2 (5αRD2) is a rare autosomal recessive disorder caused by mutations in the SRD5A2 gene. A defect in the 5-alpha reductase enzyme, which ensures conversion of testosterone into dihydrotestosterone, leads to disorders of sex development. This study presents the clinical and genetic results of patients with 5αRD2 deficiency. METHODS 5αRD2 deficiency was detected in 6 different patients from 3 unrelated families. All patients were reared as girls. Two of the patients presented with primary amenorrhea, one with primary amenorrhea and rejection of female gender, and the others with masses in their inguinal canals. Chromosome and sex-determining region Y (SRY) gene analyses were performed in all patients. Additionally, five exons of the SRD5A2 gene were amplified with polymerase chain reaction in the obtained DNA samples and evaluated. RESULTS While 46,XY was identified in 5 patients, 47,XXY was detected in one patient. The SRY gene was positive in all patients. The p.Ala65Pro (c193G>C) mutation and V89L polymorphism were observed in exon 1 of the SRD5A2 gene in all patients. CONCLUSION Identification of this mutation and polymorphism is a significant indicator of presence of 5αRD2 deficiency in Southeastern Turkey, a geographical region where consanguineous marriages are also highly common.
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Affiliation(s)
- Erdal Eren
- Harran University Faculty of Medicine, Department of Pediatric Endocrinology, Şanlıurfa, Turkey; Present position: Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey, Phone: +90 224 295 05 40 E-mail:
| | - Tuba Edgünlü
- Sıtkı Koçman University Faculty of Health Sciences, Department of Medical Biology, Muğla, Turkey
| | - Emre Asut
- Uludağ University Faculty of Medicine, Department of Pediatrics, Bursa, Turkey
| | - Sevim Karakaş Çelik
- Bülent Ecevit University Faculty of Medicine, Department of Medical Genetics, Zonguldak, Turkey
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27
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Bertelloni S, Baldinotti F, Russo G, Ghirri P, Dati E, Michelucci A, Moscuzza F, Meroni S, Colombo I, Sessa MR, Baroncelli GI. 5α-Reductase-2 Deficiency: Clinical Findings, Endocrine Pitfalls, and Genetic Features in a Large Italian Cohort. Sex Dev 2016; 10:28-36. [PMID: 27070133 DOI: 10.1159/000445090] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 11/19/2022] Open
Abstract
Clinical records (n = 24) with an established diagnosis of 5α-reductase-2 deficiency were reviewed. A previous misdiagnosis was present in about 70% (period from first observation to definitive diagnosis: 9.1 ± 10.8 years), and in 8 children gonadal removal was performed before certain diagnosis. Initial sex assignment was female in 16/24 (67%) and male in 8/24 (33%) cases. After diagnosis, sex re-assignment was performed in 5 babies (4 girls to male sex; 1 boy to female sex). Baseline testosterone/DHT ratio was diagnostic in 6/12 subjects (first months of life n = 4; puberty n = 2), while post-hCG testosterone/DHT ratio was diagnostic in all tested individuals (choosing both the cut-off value 15 or 10). Eighteen different mutations in the steroid-5α-reductase-2 (SRD5A2) gene were identified, 5 of which have never been reported. In conclusion, a time lag exists before the diagnosis of 5α-reductase-2 deficiency is established; sex assignment and gonadal removal may be performed before certain diagnosis. Sex re-assignment is usually female to male, but the contrary may occur. A large variability in clinical phenotypes and genetic mutations was present in this cohort. Accurate endocrine evaluation is recommended in babies possibly affected by 5α-reductase-2 deficiency, since the use of appropriate cut-off values of testosterone/DHT ratio after hCG stimulation may permit to select individuals for SRD5A2 gene analysis. A genotype-phenotype correlation was not found in this study.
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Affiliation(s)
- Silvano Bertelloni
- Adolescent Medicine, Pediatric Division, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
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Nistal M, Paniagua R, González-Peramato P, Reyes-Múgica M. Perspectives in Pediatric Pathology, Chapter 6. Male Undermasculinization. Pediatr Dev Pathol 2015; 18:279-96. [PMID: 25105706 DOI: 10.2350/14-04-1465-pb.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Normal male development requires three conditions: (1) adequate differentiation of the fetal testis; (2) synthesis and secretion of testicular hormones; and (3) effective action of these hormones on target organs. This requires the combined action of the inhibitory anti-müllerian hormone (AMH, secreted by Sertoli cells) to block the development of the uterus and fallopian tubes from the müllerian duct, together with the trophic stimulus of testosterone (a Leydig cell product), which leads to virilization of the wolffian ducts. Additionally, the development of external genitalia depends on the conversion of testosterone to dihydrotestosterone by the enzyme 5-α-reductase. Failure of any of these mechanisms leads to deficient virilization or the so-called "male pseudohermaphroditism" syndromes.
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Affiliation(s)
- Manuel Nistal
- 1 Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo #2, Madrid 28029, Spain
| | - Ricardo Paniagua
- 2 Department of Cell Biology, Universidad de Alcala, Madrid, Spain
| | - Pilar González-Peramato
- 1 Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo #2, Madrid 28029, Spain
| | - Miguel Reyes-Múgica
- 3 Department of Pathology, Children's Hospital of Pittsburgh of UPMC, One Children's Hospital Drive, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
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29
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Zhu H, Liu W, Han B, Fan M, Zhao S, Wang H, Lu Y, Pan C, Chen F, Chen M, Song H, Cheng K, Qiao J. Phenotypic and molecular characteristics in eleven Chinese patients with 5α-reductase Type 2 deficiency. Clin Endocrinol (Oxf) 2014; 81:711-20. [PMID: 24665940 DOI: 10.1111/cen.12456] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 11/11/2013] [Accepted: 03/21/2014] [Indexed: 11/30/2022]
Abstract
CONTEXT Steroid 5α-reductase type 2 deficiency (5α-RD2) is a male-limited, autosomal recessive inherited disease. Affected 46, XY individuals usually present with ambiguous genitalia at birth. An early and precise diagnosis is of great value to the long-term prognosis of the disease. OBJECTIVE To describe the clinical features and molecular determinants in 11 Chinese patients with the SRD5A2 gene mutation and to investigate the functional alteration arising from a novel splicing site mutation identified in one of the patients. SUBJECTS AND METHODS Eleven subjects born with abnormal external genitalia from 10 unrelated families were recruited. Among them, nine patients who were reared as girls underwent virilization and gender change after puberty. Genotyping analysis of the SRD5A2 gene was performed in each of the patients. Haplotype analysis was performed in five patients with a prevalent mutation of p.G203S to illustrate the founder effect in China. Functional impairment of the new variant was explored by an in vitro splicing study and enzymatic activity assay. RESULTS Nine mutations in the SRD5A2 gene were detected in the eleven patients. In addition to the previously reported p.G203S, p.R227Q, p.N193S, p.R246Q, p.Q6X, p.A228V, c.655delT and IVS1-2 A>G, a novel splicing site mutation (IVS4 + 2 T>C) was identified. From an in vitro functional study, this mutation was found to result in a skipping of exon 4 in the course of mRNA splicing, leading to a truncated protein of 205 amino acids that lacks the catalysing activity. Two siblings with the same compound heterozygous mutation (IVS1-2A>G/p.G203S) exhibited differing phenotypes and opposite patterns of gender rearing. A prevalent variation p.V89L combined with c.655delT was revealed to cause a mild phenotype of 5α-RD2 with a micropenis. CONCLUSION This cohort study describes the phenotypic, biochemical and long-term outcome in 11 Chinese patients with 5α-RD2 deficiency and defines the genotypic spectrum of SRD5A2 mutations in China.
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Affiliation(s)
- Hui Zhu
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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PAŠKOVÁ A, PAŘÍZEK A, HILL M, VELÍKOVÁ M, KUBÁTOVÁ J, DUŠKOVÁ M, ADAMCOVÁ K, KOUCKÝ M, ŠIMJAK P, ČERNÝ A, STÁRKA L. Steroid Metabolome in the Umbilical Cord: Is It Necessary To Differentiate Between Arterial and Venous Blood? Physiol Res 2014; 63:115-26. [DOI: 10.33549/physiolres.932624] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Steroids are important markers in pregnancy. Although estimating their levels separately in umbilical arterial (UA) and venous blood (UV) enable more precise insights into the functioning fetoplacental unit compared to using mixed umbilical blood (UM), selective aspiration of UA and UV is technically more demanding than collecting UM. We measured the levels of 67 unconjugated steroids and steroid polar conjugates in UA and UV using GC-MS in 80 women giving birth within weeks 28 to 42 of gestation. The samples were sorted into three groups: women entering labor within weeks 28-32 (group A, n=19), weeks 33-37 (group B, n=19), and weeks 38-42 (group C, n=42) of gestation, respectively. The preterm labors were due to pathologies unrelated to steroid status. Most unconjugated steroids exhibited pronounced arteriovenous differences (AVD). The AVD were less distinct in more stable steroid conjugates. Most steroids positively correlate with gestational age, but unconjugated 5β-reduced pregnanes show negative correlations, as do testosterone and androstenediol, substrates for the placental synthesis of estrogens. Tight correlations between steroids in UA and UV indicate that steroid measurements in UA, UV and UM can be accurately derived from each other, which is important for the diagnostics of steroid related diseases in newborns.
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Affiliation(s)
| | - A. PAŘÍZEK
- Department of Obstetrics and Gynecology of the First Faculty of Medicine, Charles University in Prague and General Teaching Hospital, Prague, Czech Republic
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Shabir I, Khurana ML, Marumudi E, Khadgawat R, Ammini AC. Novel nucleotide insertions in two unrelated Indian patients with 5α reductase 2 deficiency leading to premature termination of SRD5A2 enzyme. Steroids 2013; 78:1159-63. [PMID: 24012728 DOI: 10.1016/j.steroids.2013.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/31/2013] [Accepted: 08/26/2013] [Indexed: 02/03/2023]
Abstract
T is converted to a more potent androgen, DHT by the action of microsomal membrane enzyme 5α reductase 2. Defects in 5α reductase 2 isozyme results in incomplete virilisation of external male genitalia. Mutations in SRD5A2 gene leads to diminished enzyme activity, thus hampering DHT synthesis from T. We describe two unrelated patients from India with 5αRD2 due to novel insertion of nucleotides in the exon 1 of SRD5A2 gene that lead to premature termination of protein. Master S (case 1; III.8) was 3 years old at initial evaluation, had perineoscrotal hypospadias, microphallus and both testes were palpable in the inguinal region. Master P (case 2; III.9) was born as normal full term baby. He had primary complaint of microphallus, penoscrotal hypospadias and gonads in the inguinal region. Diagnosis of 5αRD2 was made, as T/DHT ratio in the two cases was 41 and 131.2 respectively. Sequence analysis of SRD5A2 gene showed an insertion of nucleotides TA in exon 1 (c.188_189). This resulted in premature termination of the protein due to stop codon at amino acid position 7. The protein formed is drastically truncated and inadequate protein synthesized explains the phenotypic characteristics of our patients.
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Affiliation(s)
- Iram Shabir
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi 29, India
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Abstract
OBJECTIVE 5α-reductases are a family of isozymes expressed in a wide host of tissues including the central nervous system (CNS) and play a pivotal role in male sexual differentiation, development and physiology. METHODS A comprehensive literature search from 1970 to 2011 was made through PubMed and the relevant information was summarized. RESULTS 5α reductases convert testosterone, progesterone, deoxycorticosterone, aldosterone and corticosterone into their respective 5α-dihydro-derivatives, which serve as substrates for 3α-hydroxysteroid dehydrogenase enzymes. The latter transforms these 5α-reduced metabolites into a subclass of neuroactive steroid hormones with distinct physiological functions. The neuroactive steroid hormones modulate a multitude of functions in human physiology encompassing regulation of sexual differentiation, neuroprotection, memory enhancement, anxiety, sleep and stress, among others. In addition, 5α -reductase type 3 is also implicated in the N-glycosylation of proteins via formation of dolichol phosphate. The family of 5α-reductases was targeted for drug development to treat pathophysiological conditions, such as benign prostatic hyperplasia and androgenetic alopecia. While the clinical use of 5α-reductase inhibitors was well established, the scope and the magnitude of the adverse side effects of such drugs, especially on the CNS, is still unrecognized due to lack of knowledge of the various physiological functions of this family of enzymes, especially in the CNS. CONCLUSION There is an urgent need to better understand the function of 5α-reductases and the role of neuroactive steroids in human physiology in order to minimize the potential adverse side effects of inhibitors targeting 5α-reductases to treat benign prostatic hyperplasia and androgenic alopecia.
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Affiliation(s)
- Abdulmaged M Traish
- Department of Urology, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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Wisniewski AB. Gender Development in 46,XY DSD: Influences of Chromosomes, Hormones, and Interactions with Parents and Healthcare Professionals. SCIENTIFICA 2012; 2012:834967. [PMID: 24278745 PMCID: PMC3820494 DOI: 10.6064/2012/834967] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 09/18/2012] [Indexed: 06/02/2023]
Abstract
Variables that impact gender development in humans are difficult to evaluate. This difficulty exists because it is not usually possible to tease apart biological influences on gender from social variables. People with disorders of sex development, or DSD, provide important opportunities to study gender within individuals for whom biologic components of sex can be discordant with social components of gender. While most studies of gender development in people with 46,XY DSD have historically emphasized the importance of genes and hormones on gender identity and gender role, more recent evidence for a significant role for socialization exists and is considered here. For example, the influence of parents' perceptions of, and reactions to, DSD are considered. Additionally, the impact of treatments for DSD such as receiving gonadal surgeries or genitoplasty to reduce genital ambiguity on the psychological development of people with 46,XY DSD is presented. Finally, the role of multi-disciplinary care including access to peer support for advancing medical, surgical and psychosexual outcomes of children and adults with 46,XY DSD, regardless of sex of rearing, is discussed.
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Affiliation(s)
- Amy B Wisniewski
- Department of Urology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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Jääskeläinen J. Molecular biology of androgen insensitivity. Mol Cell Endocrinol 2012; 352:4-12. [PMID: 21871529 DOI: 10.1016/j.mce.2011.08.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 07/19/2011] [Accepted: 08/10/2011] [Indexed: 12/29/2022]
Abstract
Androgen insensitivity syndrome (AIS) is the most common specific cause of 46,XY disorder in sex development. The androgen signaling pathway is complex but so far, the only gene linked with AIS is the androgen receptor (AR). Mutations in the AR are found in most subjects with complete AIS but in partial AIS, the rate has varied 28-73%, depending on the case selection. More than 400 different mutations in AR leading to AIS have been reported. Most mutations are missense substitutions located in the ligand binding domain of the receptor. However, when systematically screened, a substantial amount of mutations can be detected also in the N-terminal domain encoded by exon 1. Within this exon lie two trinucleotide, CAG and GGN repeat regions which are polymorphic in length. Their role in androgen insensitivity is somewhat unclear. Recent advances in protein modeling have resulted in better understanding of the mechanism of known AR mutations.
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Lagarde WH, Blackwelder AJ, Minges JT, Hnat AT, French FS, Wilson EM. Androgen receptor exon 1 mutation causes androgen insensitivity by creating phosphorylation site and inhibiting melanoma antigen-A11 activation of NH2- and carboxyl-terminal interaction-dependent transactivation. J Biol Chem 2012; 287:10905-15. [PMID: 22334658 DOI: 10.1074/jbc.m111.336081] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Naturally occurring germ line mutations in the X-linked human androgen receptor (AR) gene cause incomplete masculinization of the external genitalia by disrupting AR function in males with androgen insensitivity syndrome. Almost all AR missense mutations that cause androgen insensitivity syndrome are located in the highly structured DNA and ligand binding domains. In this report we investigate the functional defect associated with an AR exon 1 missense mutation, R405S, that caused partial androgen insensitivity. The 46,XX heterozygous maternal carrier had a wild-type Arg-405 CGC allele but transmitted an AGC mutant allele coding for Ser-405. At birth, the 46,XY proband had a bifid scrotum, hypospadias, and micropenis consistent with clinical stage 3 partial androgen insensitivity. Androgen-dependent transcriptional activity of AR-R405S expressed in CV1 cells was less than wild-type AR and refractory in androgen-dependent AR NH(2)- and carboxyl interaction transcription assays that depend on the coregulator effects of melanoma antigen-A11. This mutation created a Ser-405 phosphorylation site evident by the gel migration of an AR-R405S NH(2)-terminal fragment as a double band that converted to the wild-type single band after treatment with λ-phosphatase. Detrimental effects of the R405S mutation were related to the proximity of the AR WXXLF motif (433)WHTLF(437) required for melanoma antigen-A11 and p300 to stimulate transcriptional activity associated with the AR NH(2)- and carboxyl-terminal interaction. We conclude that the coregulator effects of melanoma antigen-A11 on the AR NH(2)- and carboxyl-terminal interaction amplify the androgen-dependent transcriptional response to p300 required for normal human male sex development in utero.
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Affiliation(s)
- William H Lagarde
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina 27599-7500, USA
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Veiga-Junior NN, Medaets PAR, Petroli RJ, Calais FL, de Mello MP, Castro CCTDS, Guaragna-Filho G, Sewaybricker LE, Marques-de-Faria AP, Maciel-Guerra AT, Guerra-Junior G. Clinical and Laboratorial Features That May Differentiate 46,XY DSD due to Partial Androgen Insensitivity and 5α-Reductase Type 2 Deficiency. Int J Endocrinol 2012; 2012:964876. [PMID: 22194745 PMCID: PMC3238364 DOI: 10.1155/2012/964876] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 10/07/2011] [Accepted: 11/03/2011] [Indexed: 01/12/2023] Open
Abstract
The aim of this study was to search for clinical and laboratorial data in 46,XY patients with ambiguous genitalia (AG) and normal testosterone (T) synthesis that could help to distinguish partial androgen insensitivity syndrome (PAIS) from 5α-reductase type 2 deficiency (5α-RD2) and from cases without molecular defects in the AR and SRD5A2 genes. Fifty-eight patients (51 families) were included. Age at first evaluation, weight and height at birth, consanguinity, familial recurrence, severity of AG, penile length, LH, FSH, T, dihydrotestosterone (DHT), Δ4-androstenedione (Δ4), and T/DHT and T/Δ4 ratios were evaluated. The AR and SRD5A2 genes were sequenced in all cases. There were 9 cases (7 families) of 5α-RD2, 10 cases (5 families) of PAIS, and 39 patients had normal molecular analysis of SRD5A2 and AR genes. Age at first evaluation, birth weight and height, and T/DHT ratio were lower in the undetermined group, while penile length was higher in this group. Consanguinity was more frequent and severity of AG was higher in 5α-RD2 patients. Familial recurrence was more frequent in PAIS patients. Birth weight and height, consanguinity, familial recurrence, severity of AG, penile length, and T/DHT ratio may help the investigation of 46,XY patients with AG and normal T synthesis.
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Affiliation(s)
- Nélio Neves Veiga-Junior
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
- Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
| | - Pedro Augusto Rodrigues Medaets
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
- Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
| | - Reginaldo José Petroli
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
- Center of Molecular Biology and Genetic Engineering (CBMEG), State University of Campinas (UNICAMP), 13083-875 Campinas, SP, Brazil
| | - Flávia Leme Calais
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
- Center of Molecular Biology and Genetic Engineering (CBMEG), State University of Campinas (UNICAMP), 13083-875 Campinas, SP, Brazil
| | - Maricilda Palandi de Mello
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
- Center of Molecular Biology and Genetic Engineering (CBMEG), State University of Campinas (UNICAMP), 13083-875 Campinas, SP, Brazil
- *Maricilda Palandi de Mello:
| | - Carla Cristina Telles de Sousa Castro
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
- Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
| | - Guilherme Guaragna-Filho
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
- Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
| | - Letícia Espósito Sewaybricker
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
- Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
| | - Antonia Paula Marques-de-Faria
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
- Department of Medical Genetics, Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
| | - Andréa Trevas Maciel-Guerra
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
- Department of Medical Genetics, Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
| | - Gil Guerra-Junior
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
- Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medical Sciences (FCM), State University of Campinas (UNICAMP), 13083-970 Campinas, SP, Brazil
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