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Lucas-Herald AK, Rodie ME, Ahmed SF. Update on the management of a newborn with a suspected difference of sex development. Arch Dis Child 2022; 107:866-871. [PMID: 34772663 DOI: 10.1136/archdischild-2020-320872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 10/26/2021] [Indexed: 11/04/2022]
Abstract
Differences or disorders of sex development are a group of heterogeneous conditions, which most commonly present in the newborn period, with the appearance of atypical genitalia on newborn examination. Over recent years, the improvement in our knowledge of these conditions has been accompanied by advances in diagnostic technology and therapeutic options, as well as societal shifts in attitudes and expectations. These factors have placed an even greater emphasis than before on the need for early expert input through a multidisciplinary service that can support the patient and the family; perform and interpret the investigations required to reach a diagnosis; and formulate a management plan that lays down the foundation for optimal long-term outcome. While providing a regional service, the expert team should also be committed to research and quality improvement through participation in national and international networks.
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Affiliation(s)
| | - Martina E Rodie
- Office for Rare Conditions, University of Glasgow, Glasgow, UK
- Department of Neonatology, Queen Elizabeth University Hospital Campus, Glasgow, UK
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
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2
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Lucas-Herald AK, Scougall K, Ahmed SF. Delivery of multidisciplinary care in the field of differences and disorders of sex development (DSD). Expert Rev Endocrinol Metab 2022; 17:225-234. [PMID: 35535380 DOI: 10.1080/17446651.2022.2072829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Differences and disorders of sex development (DSD) are a diverse group of conditions, which often present in early childhood and may require input from a group of experts in a wide range of clinical fields. Clinical guidance in this field recommends that these experts function as a multidisciplinary team (MDT) within which each expert has a defined role, which ensures an integrated and streamlined approach to the care of affected individuals. AREAS COVERED This review will focus on the benefits of multidisciplinary care for people with DSD, as well as the challenges that may be faced. EXPERT OPINION Core members of the MDT for people with DSD include endocrinologists, surgeons, psychologists, geneticists, specialist nurses, radiologists, and gynecologists, although many other health-care professionals may also be pertinent, at different stages of the patient's life. With greater acceptance of remote and digital health-care technology, there is a need to review the traditional concepts of the clinical MDT so that new care models can be explored for effective and efficient delivery of complex care.
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Affiliation(s)
| | - Kathryn Scougall
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
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Ahmed SF, Achermann J, Alderson J, Crouch NS, Elford S, Hughes IA, Krone N, McGowan R, Mushtaq T, O'Toole S, Perry L, Rodie ME, Skae M, Turner HE. Society for Endocrinology UK Guidance on the initial evaluation of a suspected difference or disorder of sex development (Revised 2021). Clin Endocrinol (Oxf) 2021; 95:818-840. [PMID: 34031907 DOI: 10.1111/cen.14528] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/30/2021] [Accepted: 05/13/2021] [Indexed: 11/26/2022]
Abstract
It is paramount that any child or adolescent with a suspected difference or disorder of sex development (DSD) is assessed by an experienced clinician with adequate knowledge about the range of conditions associated with DSD and is discussed with the regional DSD service. In most cases, the paediatric endocrinologist within this service acts as the first point of contact but involvement of the regional multidisciplinary service will also ensure prompt access to specialist psychology and nursing care. The underlying pathophysiology of DSD and the process of delineating this should be discussed with the parents and affected young person with all diagnostic tests undertaken in a timely fashion. Finally, for rare conditions such as these, it is imperative that clinical experience is shared through national and international clinical and research collaborations.
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Affiliation(s)
- S Faisal Ahmed
- Developmental Endocrinology Research Group, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK
- Office for Rare Conditions, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - John Achermann
- Genetics & Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Julie Alderson
- Psychological Health Services, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Naomi S Crouch
- Department of Women's Health, St Michael's Hospital, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | | | - Ieuan A Hughes
- DSDFamilies, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Nils Krone
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Ruth McGowan
- Developmental Endocrinology Research Group, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- West of Scotland Centre for Genomic Medicine, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Talat Mushtaq
- Department of Paediatric Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Stuart O'Toole
- Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK
- Department of Paediatric Urology, Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Leslie Perry
- Department of Clinical Biochemistry, Croydon University Hospital, London, UK
| | - Martina E Rodie
- Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK
- Office for Rare Conditions, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- Department of Neonatology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Mars Skae
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Helen E Turner
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Al-Juraibah FN, Lucas-Herald AK, Alimussina M, Ahmed SF. The evaluation and management of the boy with DSD. Best Pract Res Clin Endocrinol Metab 2018; 32:445-453. [PMID: 30086868 DOI: 10.1016/j.beem.2018.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Atypical genitalia in a boy may have a very wide and diverse aetiology and a definitive diagnosis is often challenging to reach. Detailed clinical evaluation integrated with extensive biochemical and genetic studies play an important role in this process. Such care should be undertaken in highly specialized centres that can also provide access to a multidisciplinary team for optimal long-term care.
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Affiliation(s)
- F N Al-Juraibah
- Developmental Endocrinology Research Group, University of Glasgow, UK; Department of Paediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - A K Lucas-Herald
- Developmental Endocrinology Research Group, University of Glasgow, UK
| | - M Alimussina
- Developmental Endocrinology Research Group, University of Glasgow, UK
| | - S F Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, UK.
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Zhang XH, Qiu LQ, Ye YH, Xu J. Chromosomal abnormalities: subgroup analysis by maternal age and perinatal features in zhejiang province of China, 2011-2015. Ital J Pediatr 2017; 43:47. [PMID: 28499441 PMCID: PMC5429550 DOI: 10.1186/s13052-017-0363-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/25/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Recently, the prevalence of chromosomal abnormalities (CA) increased as the increasing proportion of mothers with advanced age. We aimed to explore the prevalence of CA in relation to maternal age and perinatal features. METHODS A retrospective study was performed based on provincial birth defects surveillance data. The relative risk (RR) and 95% confidence interval (CI) were used to calculate maternal age-specific rates of CA. Socio-demographic characteristics of mothers and perinatal features were listed. RESULTS The total prevalence of CA was 6.38 per 10,000 births, which increased per 10,000 births linearly from 4.02 in 2011 to 9.13 in 2015 (x 2line-trend =52.69, p < 0.001). During this period, the prevalence for CA per 10,000 births among women over 35 years old increased from 15.34 in 2011 to 33.82 in 2015 (x 2line-trend =115121.6, p < 0.001). The RR for overall CA, trisomy 21(T21), trisomy 18(T18) and others in mothers 35 years or older were 6.64 (95% CI 5.55 ~ 7.93), 6.83 (95% CI 5.63 ~ 8.30), 4.06 (95% CI 2.09 ~ 7.90) and 7.54 (95% CI 4.02 ~ 14.11) respectively in comparison to mothers aged 25-29 years old. The stillbirths rate for total CA was 76.45%. T21 and T18 were strongly associated with multiple anomalies, especially congenital heart abnormalities. CONCLUSIONS The prevalence of CA increased as maternal age increased. Cases with CA were associated with other congenital defects and high mortality risk.
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Affiliation(s)
- Xiao-Hui Zhang
- Women's Hospital School Of Medicine Zhejiang University, No.1 Xue shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China
| | - Li-Qian Qiu
- Women's Hospital School Of Medicine Zhejiang University, No.1 Xue shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China
| | - Ying-Hui Ye
- Women's Hospital School Of Medicine Zhejiang University, No.1 Xue shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China
| | - Jian Xu
- Women's Hospital School Of Medicine Zhejiang University, No.1 Xue shi Road, Hangzhou, Zhejiang Province, 310006, People's Republic of China.
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Alhomaidah D, McGowan R, Ahmed S. The current state of diagnostic genetics for conditions affecting sex development. Clin Genet 2017; 91:157-162. [PMID: 28127758 DOI: 10.1111/cge.12912] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/28/2016] [Accepted: 10/28/2016] [Indexed: 01/07/2023]
Affiliation(s)
- D. Alhomaidah
- Developmental Endocrinology Research Group; University of Glasgow; Glasgow UK
- Paediatric Endocrine Services; Royal Hospital for Children; Glasgow UK
- Paediatric Endocrine Services; Farwaniya Hospital; Sabah Al Nasser Kuwait
| | - R. McGowan
- Developmental Endocrinology Research Group; University of Glasgow; Glasgow UK
- West of Scotland Regional Genetics Service, Laboratory Medicine Building; Queen Elizabeth University Hospital; Glasgow UK
| | - S.F. Ahmed
- Developmental Endocrinology Research Group; University of Glasgow; Glasgow UK
- Paediatric Endocrine Services; Royal Hospital for Children; Glasgow UK
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