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Mild androgen insensitivity syndrome: the current landscape. Endocr Pract 2022; 28:911-917. [PMID: 35660466 DOI: 10.1016/j.eprac.2022.05.009] [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: 04/20/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Mild Androgen Insensitivity (MAIS) belongs to the Androgen Insensitivity Syndrome (AIS) spectrum, an X-linked genetic disease that is the most common cause of differences in sex development (DSD). Unfortunately, AIS studies mainly focus on the partial and the complete phenotype, and the mild phenotype (MAIS) has been barely reported. Our purpose is to explore the MAIS facets, clinical features, and molecular aspects. METHODS We collected all reported MAIS cases in the medical literature and presented them based on the phenotype and the molecular diagnosis. RESULTS We identified 49 different AR mutations in 69 individuals in the literature. We compared the AR mutations presented in MAIS individuals with AR mutations previously reported in other AIS phenotypes (CAIS and PAIS) regarding the type, location, genotype-phenotype correlation, and functional studies. CONCLUSION This review provides a landscape of the mild phenotype of AIS. Most MAIS patients present with male infertility. Therefore, AR gene sequencing should be considered during male infertility investigation, even in males with typically male external genitalia. In addition, MAIS can be part of other medical conditions, such as X-linked spinal and bulbar muscular atrophy (Kennedy's disease).
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Hage M, Drui D, Francou B, Mercier S, Guiochon-Mantel A, Belaisch-Allart J, Péréon Y, Cazabat L, De Mazancourt P, Raffin-Sanson ML. Structural analysis of the impact of a novel androgen receptor gene mutation in two adult patients with mild androgen insensitivity syndrome. Andrologia 2020; 53:e13865. [PMID: 33108824 DOI: 10.1111/and.13865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/02/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022] Open
Abstract
Androgen receptor gene (AR) mutations are responsible for androgen insensitivity syndrome (AIS) presenting with a clinical phenotype that ranges from gynaecomastia and/ or infertility in mild AIS (MAIS) to complete testicular feminisation in complete AIS. We report a novel AR gene mutation in two unrelated adult patients with MAIS and we studied its functional impact using 3D modelling. Patient 1, referred for infertility, presented with gynaecomastia, mild hypospadias and bilateral testicular hypotrophy contrasting with high testosterone levels, an elevated FSH, an elevated androgen sensitivity index (ASI) and oligoasthenoteratospermia. In vitro fertilisation and intracytoplasmic sperm injection resulted in a successful twin pregnancy. Patient 2 referred for a decrease in athletic performance had surgically treated gynaecomastia, oligoasthenospermia, high testosterone levels and an elevated ASI. Despite his impaired spermogram, he fathered two children without assisted reproductive technology. AR gene sequencing in the two patients revealed a common novel missense mutation, Ala699Thr, in exon 4 within the ligand-binding domain. 3D modelling studies showed that this mutation may impact dimer stability upon ligand binding or may affect allosteric changes upon dimerisation. This study illustrates the value of structural analysis for the functional study of mutations and expands the database of AR gene mutations.
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Affiliation(s)
- Mirella Hage
- Centre Hospitalier Universitaire Ambroise Paré, Service d'Endocrinologie Diabétologie et Nutrition, Assistance Publique-Hôpitaux de Paris, Boulogne Billancourt, France
| | - Delphine Drui
- Centre Hospitalier Universitaire Nantes, Service d'Endocrinologie, L'institut du Thorax, Nantes, France
| | - Bruno Francou
- Centre Hospitalier Universitaire Bicêtre, Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Sandra Mercier
- Centre Hospitalier Universitaire Nantes, Service de Génétique Médicale, L'institut du Thorax, Nantes, France
| | - Anne Guiochon-Mantel
- Centre Hospitalier Universitaire Bicêtre, Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,Inserm UMR 1185, Faculté de médecine Paris Saclay, Université Paris-Saclay, le Kremlin-Bicêtre, France
| | - Joelle Belaisch-Allart
- Centre Hospitalier des Quatre Villes, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Sèvres, France
| | - Yann Péréon
- Centre Hospitalier Universitaire Nantes, Centre de Référence Maladies Neuromusculaires Nantes-Angers, Hôtel-Dieu, Nantes, France
| | - Laure Cazabat
- Centre Hospitalier Universitaire Ambroise Paré, Service d'Endocrinologie Diabétologie et Nutrition, Assistance Publique-Hôpitaux de Paris, Boulogne Billancourt, France.,EA4340, Université de Versailles Saint-Quentin-en-Yvelines, UFR des sciences de la santé Simone Veil, Montigny-le-Bretonneux, France
| | - Philippe De Mazancourt
- Centre Hospitalier Universitaire Ambroise Paré, Laboratoire de Biochimie-Génétique Moléculaire, UMR1179, Boulogne Billancourt, France
| | - Marie Laure Raffin-Sanson
- Centre Hospitalier Universitaire Ambroise Paré, Service d'Endocrinologie Diabétologie et Nutrition, Assistance Publique-Hôpitaux de Paris, Boulogne Billancourt, France.,EA4340, Université de Versailles Saint-Quentin-en-Yvelines, UFR des sciences de la santé Simone Veil, Montigny-le-Bretonneux, France
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Yabiku RS, Guaragna MS, de Sousa LM, Fabbri-Scallet H, Mazzola TN, Piveta CSC, de Souza ML, Guerra-Júnior G, de Mello MP, Maciel-Guerra AT. A Search for Disorders of Sex Development among Infertile Men. Sex Dev 2018; 12:275-280. [PMID: 30372699 DOI: 10.1159/000493877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2018] [Indexed: 11/19/2022] Open
Abstract
A retrospective cross-sectional study was performed in a DSD clinic at a tertiary service (University Hospital) to estimate the frequency of disorders of sex development (DSD) among men who seek medical care because of infertility. The sample included 84 men >20 years of age referred from 2010-2017 due to oligozoospermia or nonobstructive azoospermia of unknown etiology. Twelve cases (14%) were diagnosed as DSD, including Klinefelter Syndrome, 46,XX testicular DSD, and mild androgen insensitivity syndrome. Y chromosome microdeletions were detected in 2 patients. Among the remaining 70 cases there were patients with chromosome abnormalities which are not included in the DSD classification as well as rare NR5A1 variants of uncertain significance and hypergonadotropic hypogonadism and microorchidism in 46,XY subjects. In conclusion, the frequency of DSD in this study was 14%, consisting mainly of sex chromosome abnormalities but also 46,XX and 46,XY DSD. However, this figure may increase as further investigations are conducted in idiopathic cases with signs of primary testicular failure, which may present partial gonadal dysgenesis.
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Paris F, Gaspari L, Mbou F, Philibert P, Audran F, Morel Y, Biason-Lauber A, Sultan C. Endocrine and molecular investigations in a cohort of 25 adolescent males with prominent/persistent pubertal gynecomastia. Andrology 2016; 4:263-9. [DOI: 10.1111/andr.12145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 11/02/2015] [Accepted: 11/12/2015] [Indexed: 01/18/2023]
Affiliation(s)
- F. Paris
- Unité d'Endocrinologie-Gynécologie Pédiatriques; Département de Pédiatrie; Hôpital Arnaud-de-Villeneuve; CHU Montpellier et Université Montpellier 1 Montpellier France
- Département d'Hormonologie (Développement et Reproduction); Hôpital Lapeyronie; CHU Montpellier et Université Montpellier 1 Montpellier France
| | - L. Gaspari
- Unité d'Endocrinologie-Gynécologie Pédiatriques; Département de Pédiatrie; Hôpital Arnaud-de-Villeneuve; CHU Montpellier et Université Montpellier 1 Montpellier France
- Département de Pédiatrie; Hôpital Caremeau; CHU Nîmes; Nîmes France
| | - F. Mbou
- Département de Pédiatrie; CHU de Fort de France; Martinique
| | - P. Philibert
- Département d'Hormonologie (Développement et Reproduction); Hôpital Lapeyronie; CHU Montpellier et Université Montpellier 1 Montpellier France
| | - F. Audran
- Département d'Hormonologie (Développement et Reproduction); Hôpital Lapeyronie; CHU Montpellier et Université Montpellier 1 Montpellier France
| | - Y. Morel
- Centre de Biologie et Pathologie Est; Bron France
| | - A. Biason-Lauber
- Department of Medicine; University of Fribourg; Fribourg Switzerland
| | - C. Sultan
- Unité d'Endocrinologie-Gynécologie Pédiatriques; Département de Pédiatrie; Hôpital Arnaud-de-Villeneuve; CHU Montpellier et Université Montpellier 1 Montpellier France
- Département d'Hormonologie (Développement et Reproduction); Hôpital Lapeyronie; CHU Montpellier et Université Montpellier 1 Montpellier France
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