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Reddy DS, Danda VSR, Paidipally SR. Phenotype variation among siblings with 5-alpha reductase deficiency: A case series. Indian J Urol 2021; 37:183-186. [PMID: 34103805 PMCID: PMC8173944 DOI: 10.4103/iju.iju_340_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/06/2020] [Accepted: 11/20/2020] [Indexed: 11/25/2022] Open
Abstract
Steroid 5α-reductase deficiency (5ARD) is a rare autosomal recessive disorder caused by mutation in the 5α-reductase type 2 gene (SRD5A2). 5ARD results in the impaired conversion of testosterone (T) to dihydrotestosterone (DHT) and is characterized by undervirilization in 46XY individuals. We report a case series of three siblings presenting with ambiguous genitalia and different phenotypes. They did not meet the widely accepted biochemical criteria for 5ARD. In view of strong clinical suspicion, genetic analysis was performed which revealed pathogenic mutation in SRD5A2. This report highlights the importance of definitive diagnosis with molecular methods as the treatment and prognosis differs greatly among the close differential diagnoses. Reliance on the biochemical criteria alone may lead to misdiagnosis.
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Affiliation(s)
- D Sandeep Reddy
- Department of Endocrinology, Gandhi Medical College and Hospital, Secunderabad, Hyderabad, Telangana, India
| | - Vijay Sheker Reddy Danda
- Department of Endocrinology, Gandhi Medical College and Hospital, Secunderabad, Hyderabad, Telangana, India
| | - Srinivas Rao Paidipally
- Department of Endocrinology, Gandhi Medical College and Hospital, Secunderabad, Hyderabad, Telangana, India
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Batista RL, Mendonca BB. Integrative and Analytical Review of the 5-Alpha-Reductase Type 2 Deficiency Worldwide. APPLICATION OF CLINICAL GENETICS 2020; 13:83-96. [PMID: 32346305 PMCID: PMC7167369 DOI: 10.2147/tacg.s198178] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/20/2020] [Indexed: 12/12/2022]
Abstract
Introduction The conversion of testosterone into dihydrotestosterone is catalyzed by the 5α-reductase type 2 enzyme which plays a crucial role in the external genitalia virilization. It is encoded by the SRD5A2 gene. Allelic variants in this gene cause a 46,XY DSD with no genotype-phenotype relationship. It was firstly reported in the early 70s from isolated clusters. Since then, several cases have been reported. Putting together, it will expand the knowledge on the molecular bases of androgen milieu. Methods We searched for SRD5A2 allelic variants (AV) in the literature (PubMed, Embase, MEDLINE) and websites (ensembl, HGMD, ClinVar). Only cases with AV in both alleles, either in homozygous or compound heterozygous were included. The included cases were analyzed according to ethnicity, exon, domain, aminoacid (aa) conservation, age at diagnosis, sex assignment, gender reassignment, external genitalia virilization and functional studies. External genitalia virilization was scored using Sinnecker scale. Conservation analysis was carried out using the CONSURF platform. For categorical variables, we used X2 test and Cramer's V. Continuous variables were analyzed by t test or ANOVA. Concordance was estimated by Kappa. Results We identified 434 cases of 5ARD2 deficiencies from 44 countries. Most came from Turkey (23%), China (17%), Italy (9%), and Brazil (7%). Sixty-nine percent were assigned as female. There were 70% of homozygous allelic variants and 30% compound heterozygous. Most were missense variants (76%). However, small indels (11%), splicing (5%) and large deletions (4%) were all reported. They were distributed along with all exons with exon 1 (33%) and exon 4 (25%) predominance. Allelic variants in the exon 4 (NADPH-binding domain) resulted in lower virilization (p<0.0001). The codons 55, 65, 196, 235 and 246 are hotspots making up 25% of all allelic variants. Most of them (76%) were located at conserved aa. However, allelic variants at non-conserved aa were more frequently indels (28% vs 6%; p<0.01). The overall rate of gender change from female to male ranged from 16% to 70%. The lowest rate of gender change from female to male occurred in Turkey and the highest in Brazil. External genitalia virilization was similar between those who changed and those who kept their assigned gender. The gender change rate was significantly different across the countries (V=0.44; p<0.001) even with similar virilization scores. Conclusion 5ARD2 deficiency has a worldwide distribution. Allelic variants at the NADPH-ligand region cause lower virilization. Genitalia virilization influenced sex assignment but not gender change which was influenced by cultural aspects across the countries. Molecular diagnosis influenced on sex assignment, favoring male sex assignment in newborns with 5α-reductase type 2 deficiency.
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Affiliation(s)
- Rafael Loch Batista
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia, do Departamento de Clínica Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Berenice Bilharinho Mendonca
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia, do Departamento de Clínica Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Krzemińska P, D'Anza E, Ciotola F, Paciello O, Restucci B, Peretti V, Albarella S, Switonski M. Polymorphisms of MAMLD1, SRD5A2, and AR Candidate Genes in Seven Dogs (78,XY; SRY-Positive) Affected by Hypospadias or Cryptorchidism. Sex Dev 2019; 13:92-98. [PMID: 31055572 DOI: 10.1159/000500219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2019] [Indexed: 12/27/2022] Open
Abstract
Knowledge of the molecular background of disorders of sex development (DSD) in dogs with normal sets of XY chromosomes (XY DSD) is very scarce. However, extensive studies have been carried out in humans, showing that polymorphisms and mutations of numerous genes, including SRY, MAMLD1, SRD5A2, and AR, are associated with or responsible for XY DSD. In this study, we analyzed the entire coding sequence of these genes in 7 dogs (78,XY) with ambiguous external genitalia (hypospadias, cryptorchidism, bifid scrotum, or rudimentary penis). The most common disorder was hypospadias (6 cases), followed by cryptorchidism (4 cases). The co-occurrence of both abnormalities was observed in 3 dogs. Polymorphisms were found in MAMLD1 (3 SNPs), SRD5A2 (5 SNPs), and AR (2 STRs and 1 SNP), while SRY was monomorphic. However, the distribution of the polymorphic variants in the DSD dogs and 11 control XY dogs did not differ significantly. Our study suggests that an association between the polymorphisms of the studied candidate genes and hypospadias or cryptorchidism is unlikely in dogs. We thus support the recent suggestion that hypospadias is not rare in this species, and moreover, we show that co-occurrence of hypospadias and cryptorchidism can be quite frequent.
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Avendaño A, Paradisi I, Cammarata-Scalisi F, Callea M. 5-α-Reductase type 2 deficiency: is there a genotype-phenotype correlation? A review. Hormones (Athens) 2018; 17:197-204. [PMID: 29858846 DOI: 10.1007/s42000-018-0013-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/05/2018] [Indexed: 12/12/2022]
Abstract
5-α-Reductase type 2 enzyme catalyzes the conversion of testosterone into dihydrotestosterone, a potent androgen responsible for male sexual development during the fetal period and later during puberty. Its deficiency causes an autosomal recessive disorder of sex development characterized by a wide range of under-virilization of external genitalia in patients with a 46,XY karyotype. Mutations in the SRD5A2 gene cause 5-α-Reductase deficiency; although it is an infrequent disorder, it has been reported worldwide, with mutational heterogeneity. Furthermore, it has been proposed that there is no genotype-phenotype correlation, even in patients carrying the same mutation. The aim of this review was to perform an extensive search in various databases and to select those articles with a comprehensive genotype and phenotype description of the patients, classifying their phenotypes using the external masculinization score (EMS). Thus, it was possible to objectively compare the eventual genotype-phenotype correlation between them. The analysis showed that for most of the studied mutations no correlation can be established, although the specific location of the mutation in the protein has an effect on the severity of the phenotype. Nevertheless, even in patients carrying the same homozygous mutation, a variable phenotype was observed, suggesting that additional genetic factors might be influencing it. Due to the clinical variability of the disorder, an accurate diagnosis and adequate medical management might be difficult to carry out, as is highlighted in the review.
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MESH Headings
- 3-Oxo-5-alpha-Steroid 4-Dehydrogenase/blood
- 3-Oxo-5-alpha-Steroid 4-Dehydrogenase/deficiency
- 3-Oxo-5-alpha-Steroid 4-Dehydrogenase/genetics
- Disorder of Sex Development, 46,XY/blood
- Disorder of Sex Development, 46,XY/genetics
- Disorder of Sex Development, 46,XY/pathology
- Disorder of Sex Development, 46,XY/therapy
- Genitalia/abnormalities
- Genotype
- Humans
- Hypospadias/blood
- Hypospadias/genetics
- Hypospadias/pathology
- Hypospadias/therapy
- Phenotype
- Steroid Metabolism, Inborn Errors/blood
- Steroid Metabolism, Inborn Errors/genetics
- Steroid Metabolism, Inborn Errors/pathology
- Steroid Metabolism, Inborn Errors/therapy
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Affiliation(s)
- Andrea Avendaño
- Medicine Faculty, Medical Genetics Unit, Los Andes University, Mérida, Venezuela
| | - Irene Paradisi
- Human Genetics Laboratory, Venezuelan Institute for Scientific Research (IVIC), Caracas, Venezuela.
| | | | - Michele Callea
- Unit of Dentistry, Bambino Gesù Children's Hospital, Rome, Italy
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Bramble MS, Lipson A, Vashist N, Vilain E. Effects of chromosomal sex and hormonal influences on shaping sex differences in brain and behavior: Lessons from cases of disorders of sex development. J Neurosci Res 2017; 95:65-74. [PMID: 27841933 DOI: 10.1002/jnr.23832] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/30/2016] [Accepted: 06/20/2016] [Indexed: 01/15/2023]
Abstract
Sex differences in brain development and postnatal behavior are determined largely by genetic sex and in utero gonadal hormone secretions. In humans however, determining the weight that each of these factors contributes remains a challenge because social influences should also be considered. Cases of disorders of sex development (DSD) provide unique insight into how mutations in genes responsible for gonadal formation can perturb the subsequent developmental hormonal milieu and elicit changes in normal human brain maturation. Specific forms of DSDs such as complete androgen insensitivity syndrome (CAIS), congenital adrenal hyperplasia (CAH), and 5α-reductase deficiency syndrome have variable effects between males and females, and the developmental outcomes of such conditions are largely dependent on sex chromosome composition. Medical and psychological works focused on CAH, CAIS, and 5α-reductase deficiency have helped form the foundation for understanding the roles of genetic and hormonal factors necessary for guiding human brain development. Here we highlight how the three aforementioned DSDs contribute to brain and behavioral phenotypes that can uniquely affect 46,XY and 46,XX individuals in dramatically different fashions. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Matthew S Bramble
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Allen Lipson
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Neerja Vashist
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Eric Vilain
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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Rahimi M, Ghanbari M, Fazeli Z, Rouzrokh M, Omrani S, Mirfakhraie R, Omrani MD. Association of SRD5A2 gene mutations with risk of hypospadias in the Iranian population. J Endocrinol Invest 2017; 40:391-396. [PMID: 27848231 DOI: 10.1007/s40618-016-0573-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/26/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hypospadias is one of the most common forms of congenital malformation of the male external genitalia worldwide. The ratio in the Iranian population is one in 250 live male births. The conversion of testosterone to dihydrotestosterone (DHT) in the presence of steroid 5α-reductase 2, which is encoded by SRD5A2 gene, plays an important role in the normal development of the male reproductive system. METHODS We examined whether SRD5A2 gene mutations (V89L and A49T polymorphisms) are associated with the risk of hypospadias in the Iranian population. We performed exons sequencing for SRD5A2 gene in 109 hypospadias patients. RESULTS We identified two new mutations in the subgroups of affected cases: including a substitution of the nucleotide T > A in the codon 73 [c.219T > A (p.Leu73_Ser74insHisPro)] and an insertion of an extra A nucleotide in the codon 77 [c.229insA* (p.Gly77*)]. Additionally, we performed PCR-RFLP for the two identified polymorphisms and revealed that V89L [OR = 5.8, 95% CI (3.8-8.8), p value < 0.001] and A49T [OR = 10.16, 95% CI (3.94-26.25), p value < 0.001] are significantly associated with hypospadias occurrence in patients. Our haplotype analysis further indicated that the Leu-Ala haplotype increases risk of hypospadias; conversely, the Val-Ala haplotype decreases the risk of hypospadias in the studied patients. CONCLUSIONS This study demonstrates that polymorphisms in the SRD5A2 gene could be considered as a risk factor for hypospadias disease emergence.
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Affiliation(s)
- M Rahimi
- Department of Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Koodakyar St., Daneshjoo Blvd., Evin, Chamran Highway, Tehran, Iran
| | - M Ghanbari
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Z Fazeli
- Department of Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Koodakyar St., Daneshjoo Blvd., Evin, Chamran Highway, Tehran, Iran
| | - M Rouzrokh
- Department of Pediatric Surgery, Mofid Children's Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Omrani
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - R Mirfakhraie
- Department of Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Koodakyar St., Daneshjoo Blvd., Evin, Chamran Highway, Tehran, Iran.
| | - M D Omrani
- Department of Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Koodakyar St., Daneshjoo Blvd., Evin, Chamran Highway, Tehran, Iran.
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French JA, Frye B, Cavanaugh J, Ren D, Mustoe AC, Rapaport L, Mickelberg J. Gene changes may minimize masculinizing and defeminizing influences of exposure to male cotwins in female callitrichine primates. Biol Sex Differ 2016; 7:28. [PMID: 27257473 PMCID: PMC4890500 DOI: 10.1186/s13293-016-0081-y] [Citation(s) in RCA: 8] [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: 12/30/2015] [Accepted: 05/24/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Sexual differentiation in female mammals can be altered by the proximity of male littermates in utero, a phenomenon known as the intrauterine position effect (IUP). Among simian primates, callitrichines (marmosets and tamarins) are likely candidates for IUP, since they exhibit obligate dizygotic twinning and fetuses share extensive vascularization in utero. In this paper, we determined whether female reproductive parameters are altered by gestating with a male twin and evaluated changes in genes associated with anti-Müllerian and steroid hormones in twinning callitrichine primates. METHODS We assessed the impact of gestation with male cotwins on reproductive performance and survivorship in female marmosets (Callithrix) and lion tamarins (Leontopithecus), contrasting measures for females gestated with one or more littermates (M+) or no male littermates (0M). We compared targeted coding regions for genes involved in steroidal and anti-Müllerian hormone mediation of sexual differentiation for representatives of twinning callitrichines (Callithrix, Saguinus, and Leontopithecus) with closely related New World primates that produce single births (Saimiri and Callimico). RESULTS IUP effects in females were absent in female callitrichine primates: age at first ovulation, average litter size, and the proportion of stillborn infants, and lifetime survivorship did not differ between M+ and 0M females. We documented multiple nonsynonymous substitutions in genes associated with steroid synthesis, transport, and cellular action (SRD5A2, CYP19A1, SHBG, and AR) and with anti-Müllerian hormone (AMH and AMHR2) in callitrichines. In the only callitrichine to produce single infants (Callimico), two genes contained nonsynonymous substitutions relative to twinning callitrichines (CYP19A1 and AMRHR2); these substitutions were identical with nontwinning Saimiri and humans, suggesting a reversion to an ancestral sequence. CONCLUSIONS In spite of a shared placental vasculature with opposite-sex twins throughout embryonic and fetal development, female callitrichine primates gestated with a male cotwin exhibit no decrement in reproductive performance relative to females gestated with female cotwins. Hence, IUP effects on female reproduction in callitrichines are modest. We have identified mutations in candidate genes relevant for steroid hormone signaling and metabolism, and especially in AMH-related genes, that are likely to alter protein structure and function in the callitrichines. These mutations may confer protection for females from the masculinizing and defeminizing influences of gestating with a male cotwin.
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Affiliation(s)
- Jeffrey A French
- Callitrichid Research Center, Department of Psychology, University of Nebraska at Omaha, Omaha, 68182 NE USA
| | - Brett Frye
- Department of Biology, Clemson University, Clemson, 29634 SC USA
| | - Jon Cavanaugh
- Callitrichid Research Center, Department of Psychology, University of Nebraska at Omaha, Omaha, 68182 NE USA
| | - Dongren Ren
- Callitrichid Research Center, Department of Psychology, University of Nebraska at Omaha, Omaha, 68182 NE USA
| | - Aaryn C Mustoe
- Callitrichid Research Center, Department of Psychology, University of Nebraska at Omaha, Omaha, 68182 NE USA
| | - Lisa Rapaport
- Department of Biology, Clemson University, Clemson, 29634 SC 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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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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Zaccara A, Silveri M, Capitanucci ML, Mosiello G, De Gennaro M, Bizzarri C, Cappa M, Orazi C. Prenatal hydrocolpos in a male. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2014.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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