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Ekenze SO, Chikani U, Ezomike UO, Adiri CO, Onuh A. Clinical profile and management challenges of disorders of sex development in Africa: a systematic review. J Pediatr Endocrinol Metab 2022; 35:139-146. [PMID: 34670035 DOI: 10.1515/jpem-2021-0510] [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: 08/01/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To review the published literature regarding disorders of sex development (DSD) in Africa which will highlight clinical characteristics, and challenges of evaluation and treatment of DSD. CONTENT We performed systematic review of articles published on DSD in Africa between January 2001 and December 2020. SUMMARY Eighteen studies involving 1980 patients from nine countries were analyzed. Overall mean age at presentation was 9.3 years (range 1 day-33 years) with 52.5 and 45.1% reared as females and males, respectively, prior to presentation. Following evaluation however, 64% were assigned female sex, 32.1% were assigned male sex, and 21.8% of the cases required sex reassignment. Only 7 (38.9%) of the publications reported medical treatment of DSD, 4 (22.2%) reported on psychosocial management and 5 (27.8%) documented multidisciplinary team management. Barring regional variations, the documented challenges of management include delayed presentation, loss to follow up, financial challenges, and lack of facilities for care of DSD. Comparison of the cases managed in the last decade (2011-2020) with those managed in the earlier decade (2001-2010) showed a trend towards earlier presentation and reduced rate of sex reassignment in the last decade. However, the challenges persisted. OUTLOOK Barring regional differences, a high proportion of DSD in Africa may have delayed presentation with inappropriate sex of rearing, inadequate evaluation and need for sex reassignment. Specific efforts to improve time to diagnosis, patient evaluation, improvement of healthcare funding, and collaboration with more developed countries may improve the care of patients with DSD in Africa.
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Affiliation(s)
- Sebastian O Ekenze
- Sub-Department of Paediatric Surgery, Faculty of Medical Sciences, College of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Ugo Chikani
- Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Uchechukwu O Ezomike
- Sub-Department of Paediatric Surgery, Faculty of Medical Sciences, College of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Charles O Adiri
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Augustine Onuh
- Department of Radiation Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu, Nigeria
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Ali MA, Maalman RSE, Donkor YO, Mensah JE. Ambiguous genitalia: clinical management of adult female with male assigned gender: a case report. J Med Case Rep 2021; 15:362. [PMID: 34253226 PMCID: PMC8273980 DOI: 10.1186/s13256-021-02914-2] [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: 02/19/2021] [Accepted: 05/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disorders of sex development are anomalies in which the development of urogenital ridge is undifferentiated for the male and female child. Imaging plays a vital role in investigating the gross anatomy and associated anomalies. Ultrasonography, such as genitography and magnetic resonance, is the primary modality for demonstrating internal gonads and genitalia. Early multidisciplinary approach in the management of ambiguous genitalia including early surgical intervention is the predominant practice, with few current considerations on deferral of genital reconstruction until adolescent age. CASE PRESENTATION We report the rare case of a 24-year-old adult female from a majority ethnic group of the Volta region, Ghana who was diagnosed and raised as male, now requiring surgical restoration to the female gender. The surgical team decided to assign external genitalia to correspond with the already intact internal organs, thus constructing the vulva. Consent was given by the client and her family members for management and surgical intervention. The surgery was scheduled and duly performed with a successful outcome. Understanding and consent was sought from the patient for the purpose of using her images for teaching, scientific publication, and demonstrations. CONCLUSION The advantages of deferring surgical reconstruction with psychological counseling after early assessment need to be considered to prevent inappropriate gender assignment.
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Affiliation(s)
- Mahamudu Ayamba Ali
- Department of Basic Medical Sciences, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana.,Consultant Urologist, Department of Surgery, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Raymond Saa-Eru Maalman
- Department of Basic Medical Sciences, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Yaw Otchere Donkor
- Department of Basic Medical Sciences, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana.
| | - James Edward Mensah
- Consultant Urologist, Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana.,School of medicine and Dentistry, University of Ghana, College of Health Sciences, Accra, Ghana
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Ata A, Özen S, Onay H, Uzun S, Gökşen D, Özkınay F, Özbaran NB, Ulman İ, Darcan Ş. A large cohort of disorders of sex development and their genetic characteristics: 6 novel mutations in known genes. Eur J Med Genet 2021; 64:104154. [PMID: 33516834 DOI: 10.1016/j.ejmg.2021.104154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/03/2020] [Accepted: 01/25/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Disorders of sex development (DSD) constitutes a group of congenital conditions that affect urogenital differentiation and are associated with chromosomal, gonadal and phenotypic sex abnormalities. OBJECTIVE To evaluate the clinical and genetic features of childhood DSD cases. MATERIALS AND METHODS DSD patients followed up between the years of 2002-2018 were evaluated in terms of their complaints, demographic, clinical features and genetic diagnoses. RESULTS Out of 289 patients, 143(49.5%) were classified as 46XY DSD, 62(21.5%) as 46XX DSD and 84(29%) as sex chromosomal DSD. Genetic diagnosis was achieved in 150 patients (51.9%). The distribution of the molecular diagnosis of the 46XY DSD patients were; 12 (26.6%) SRD5A2, 10 (22.2%) AR, 7 (15.5%) HSD17B3, 3 (6.6%) WT-1, 2 (4.4%) AMHR2, 2 (4.4%) AMH, 2 (4.4%) LHCGR, 2 (4.4%) HSD3B2, 1 (2.2%) NR5A1, 1 (2.2%) CYP17A1 and 1 (2.2%) SRY mutation. Fifty (80.6%) of the 46XX DSD patients received a diagnosis with clinical and laboratory findings. Twenty-four (38.7%) of them were 21-hydroxylase deficiency, 9(14.5%) Rokitansky-Küster-Hauser Syndrome, 4 (6.5%) 11-β hydroxylase deficiency, 3 (4.8%) gonadal dysgenesis and 2 (3.2%) aromatase deficiency. In 46XX group pathogenic mutations were detected in 21(33.8%) of the patients. Eighty-four (29%) patients were diagnosed as sex chromosomal disorder. Of these 66 (78.5%) were Turner Syndrome, 6 (7.2%) Klinefelter Syndrome and 10 (11.9%) mix gonadal dysgenesis. Gender re-assignment was decided in 11 patients. Malignant and pre-invasive lesions was diagnosed in 8 (2.7%) patients. CONCLUSION Many of DSD's are clinically similar and etiology of numerous of them still cannot be established. A multi-disciplinary approach and new rapid genetic diagnostic methods are needed in the process from diagnosis to gender assignment and follow-up.
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Affiliation(s)
- Aysun Ata
- Department of Pediatric Endocrinology and Diabetes, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Samim Özen
- Department of Pediatric Endocrinology and Diabetes, Faculty of Medicine, Ege University, Izmir, Turkey.
| | - Hüseyin Onay
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Selin Uzun
- Department of Child Health and Diseases, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Damla Gökşen
- Department of Pediatric Endocrinology and Diabetes, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ferda Özkınay
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, Turkey; Department of Pediatric Genetics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Nazlı Burcu Özbaran
- Department of Pediatric and Adolescent Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
| | - İbrahim Ulman
- Department of Pediatric Urology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Şükran Darcan
- Department of Pediatric Endocrinology and Diabetes, Faculty of Medicine, Ege University, Izmir, Turkey
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Costagliola G, Cosci O di Coscio M, Masini B, Baldinotti F, Caligo MA, Tyutyusheva N, Sessa MR, Peroni D, Bertelloni S. Disorders of sexual development with XY karyotype and female phenotype: clinical findings and genetic background in a cohort from a single centre. J Endocrinol Invest 2021; 44:145-151. [PMID: 32378143 DOI: 10.1007/s40618-020-01284-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/28/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE 46, XY disorders (or differences) of sex development (DSD) are a group of clinical conditions with variable genetic background; correct diagnosis is often difficult, but it permits to optimize the management. The aim of this study is to identify clinical and genetics features of a group of women with 46, XY DSD to define some issues characterizing people with 46, XY DSD in Italy. METHODS Retrospective analysis of girls and women with 46, XY DSD and female phenotype evaluated between year 2000 and 2016, performed by anonymised database, focusing on the clinical features and management, including presentation, first diagnostic suspect, gonadal surgery and molecular diagnostic delay. RESULTS A total of 84 records were collected (mean age at clinical presentation: 9.1 ± 7.9 years; mean age at definitive diagnosis: 20.1 ± 15.0 years). Complete androgen insensitivity syndrome was the most common diagnosis (60%). Only 12 patients (14.3%) did not receive a molecular diagnosis. Early misdiagnoses frequently occurred; diagnostic delay was 10.2 ± 11.2 years, being reduced in patients presenting from 2007 to 2016. The discordance between genotypic and phenotypic sex during pregnancy or at birth determined early reason for referral in a considerable percentage (4.9%). CONCLUSION Misdiagnosis and long diagnostic delays are present in females with 46, XY DSD in Italy, but the new genetic techniques permit faster right diagnoses in the last years. The centralization in dedicated third level units permits to reduce the number of patients without a molecular diagnosis, allowing better clinical management and appropriate genetic counselling.
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Affiliation(s)
- G Costagliola
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Pediatric and Adolescent Endocrinology, University of Pisa, Pisa, Italy
| | - M Cosci O di Coscio
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Pediatric and Adolescent Endocrinology, University of Pisa, Pisa, Italy
| | - B Masini
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Pediatric and Adolescent Endocrinology, University of Pisa, Pisa, Italy
| | - F Baldinotti
- Laboratory of Molecular Genetics, Azienda Ospedaliero Universitaria Pisa, Pisa, Italy
| | - M A Caligo
- Laboratory of Molecular Genetics, Azienda Ospedaliero Universitaria Pisa, Pisa, Italy
| | - N Tyutyusheva
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Pediatric and Adolescent Endocrinology, University of Pisa, Pisa, Italy
| | - M R Sessa
- Laboratory of Endocrinology, Azienda Ospedaliero Universitaria Pisa, Pisa, Italy
| | - D Peroni
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Pediatric and Adolescent Endocrinology, University of Pisa, Pisa, Italy
| | - S Bertelloni
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Pediatric and Adolescent Endocrinology, University of Pisa, Pisa, Italy.
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Gürbüz F, Alkan M, Çelik G, Bişgin A, Çekin N, Ünal İ, Topaloğlu AK, Zorludemir Ü, Avcı A, Yüksel B. Gender Identity and Assignment Recommendations in Disorders of Sex Development Patients: 20 Years’ Experience and Challenges. J Clin Res Pediatr Endocrinol 2020; 12:347-357. [PMID: 32212580 PMCID: PMC7711639 DOI: 10.4274/jcrpe.galenos.2020.2020.0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Gender assignment in infants and children with disorders of sex development (DSD) is a stressful situation for both patient/families and medical professionals. METHODS The purpose of this study was to investigate the results of gender assignment recommendations in children with DSD in our clinic from 1999 through 2019. RESULTS The mean age of the 226 patients with DSD at the time of first admission were 3.05±4.70 years. 50.9% of patients were 46,XY DSD, 42.9% were 46,XX DSD and 6.2% were sex chromosome DSD. Congenital adrenal hyperplasia (majority of patients had 21-hydroxylase deficiency) was the most common etiological cause of 46,XX DSD. In 46,XX patients, 87 of 99 (89.7%) were recommended to be supported as a female, 6 as a male, and 4 were followed up. In 46,XY patients, 40 of 115 (34.8%) were recommended to be supported as a female, and 70 as male (60.9%), and 5 were followed up. In sex chromosome DSD patients, 3 of 14 were recommended to be supported as a female, 9 as a male. The greatest difficulty in making gender assignment recommendations were in the 46,XY DSD group. CONCLUSION In DSD gender assignment recommendations, the etiologic diagnosis, psychiatric gender orientation, expectation of the family, phallus length and Prader stage were effective in the gender assignment in DSD cases, especially the first two criteria. It is important to share these experiences among the medical professionals who are routinely charged with this difficult task in multidisciplinary councils.
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Affiliation(s)
- Fatih Gürbüz
- Çukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey
| | - Murat Alkan
- Çukurova University Faculty of Medicine, Department of Pediatric Surgery, Adana, Turkey
| | - Gonca Çelik
- Çukurova University Faculty of Medicine, Department of Child Psychiatry, Adana, Turkey
| | - Atıl Bişgin
- Çukurova University Faculty of Medicine, Department of Medical Genetics, Adana, Turkey
| | - Necmi Çekin
- Çukurova University Faculty of Medicine, Department of Forensic Medicine, Adana, Turkey
| | - İlker Ünal
- Çukurova University Faculty of Medicine, Department of Biostatistics, Adana, Turkey
| | - Ali Kemal Topaloğlu
- Çukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey
| | - Ünal Zorludemir
- Çukurova University Faculty of Medicine, Department of Pediatric Surgery, Adana, Turkey
| | - Ayşe Avcı
- Çukurova University Faculty of Medicine, Department of Child Psychiatry, Adana, Turkey
| | - Bilgin Yüksel
- Çukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey,* Address for Correspondence: Çukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey Phone: +90 532 516 91 31 E-mail:
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Aydin BK, Saka N, Bas F, Bas EK, Coban A, Yildirim S, Guran T, Darendeliler F. Frequency of Ambiguous Genitalia in 14,177 Newborns in Turkey. J Endocr Soc 2019; 3:1185-1195. [PMID: 31139765 PMCID: PMC6532673 DOI: 10.1210/js.2018-00408] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/05/2019] [Indexed: 11/19/2022] Open
Abstract
CONTEXT Limited data are available on the exact incidence of disorders of sex development (DSD) with genital ambiguity at birth. OBJECTIVE To determine frequency of ambiguous genitalia in newborns. DESIGN Prospective multicenter study. SETTING Three tertiary care hospitals. PATIENTS OR OTHER PARTICIPANTS All 14,177 babies born during the study period were included. MAIN OUTCOME MEASURES All newborns were examined at birth; data on weeks of gestation, birth weight, and length were collected. A structured questionnaire was used for data collection. Quigley and Prader scales were used for phenotypic grading. Clinical and genetic investigations were performed. RESULTS Eighteen babies with ambiguous genitalia were found among 14,177 newborns (1.3/1000). Fifteen newborns had 46,XY DSD, one had 46,XX congenital adrenal hyperplasia, and one had 45,X/46,XY mixed gonadal dysgenesis. Karyotype analysis was not done in one baby who died in the neonatal period. The ratio of prematurity was higher in the DSD group (44% vs 11%; P < 0.001) and the ratio of small for gestational age was also higher in the DSD group (22% vs 5%; P = 0.007). Eight babies with DSD had mothers who had additional medical conditions, such as preeclampsia, depression, insulin resistance, and gestational diabetes mellitus. CONCLUSION The frequency of ambiguous genitalia was higher than in previous studies, but, as with any experiment, the finding should be met with caution because this study was conducted in tertiary care hospitals. In addition, lower birth weight in the DSD group supports the hypothesis that early placental dysfunction might be important in the etiology of male genital anomalies.
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Affiliation(s)
- Banu Kucukemre Aydin
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
- Pediatric Endocrinology Unit, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Nurcin Saka
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Firdevs Bas
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Evrim Kiray Bas
- Neonatology Unit, Sisli Etfal Training and Research Hospital, Instanbul, Turkey
| | - Asuman Coban
- Department of Pediatrics, Neonatology Unit, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sukran Yildirim
- Department of Pediatrics, Neonatology Unit, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Tulay Guran
- Pediatric Endocrinology Unit, Zeynep Kamil Women's and Children's Hospital, Istanbul, Turkey
- Department of Pediatrics, Pediatric Endocrinology Unit, Marmara University, Faculty of Medicine, Istanbul, Turkey
| | - Feyza Darendeliler
- Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Manzoor J, Aftab S, Yaqoob M. Ambiguous genitalia: An overview of 7 years experience at the Children's Hospital & Institute of Child Health, Lahore, Pakistan. Pak J Med Sci 2019; 35:151-155. [PMID: 30881414 PMCID: PMC6408627 DOI: 10.12669/pjms.35.1.289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine the classification and etiological diagnosis of children presented with ambiguous genitalia/atypical genitalia according to the newer classification system of Disorder of Sex Development (DSD). Methods: This observational, cross-sectional study was conducted at the Department of Pediatric Endocrinology and Diabetes at The Children’s Hospital &Institute of Child Health, Lahore from January, 2007 to December; 2014. Files of all the children with ambiguous genitalia were retrospectively analyzed and relevant data was retrieved. All the information was recorded on predesigned proforma and analyzed accordingly. Results: A total of 300 cases of ambiguous genitalia classified according to the new DSD classification. 46, XX DSD were 54.3% (n=163), 46, XY DSD were 43.7% (n=131), sex chromosome DSD were 2% (n=6). Among 46, XX DSD cases, the most common cause was congenital adrenal hyperplasia (97%, n=158). However, in 46, XY DSD partial androgen insensitivity/5α-reductase deficiency (62%. n=81) constituted the most commonest disorder. Other causes of 46XY DSD include testosterone synthesis defect(23%), congenital adrenal hyperplasia (CAH,12%), testis regression syndrome (1.5%) and persistent mullerian duct syndrome (PMDS,1.5%). Sex chromosome disorder constituted one case of iso-chromosome X turner syndrome, mixed gonadal dysgenesis (n=3), ovotesticular DSD/chimerism (n=2). Conclusion: Ambiguous genitalia have varied etiologies, 46; XXDSD found being the commonest of all, showing predominance of CAH especially salt loosing type. The early detection and prompt treatment of cases of ambiguous genitalia plays a pivotal role in the management of acute life threatening condition and gender assignment.
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Affiliation(s)
- Jaida Manzoor
- Dr. Jaida Manzoor, MBBS, FCPS. Associate Professor (Pediatric Endocrinology), Department of Pediatric Endocrinology and Diabetes, The Children's Hospital & Institute of Child Health, Lahore, Pakistan
| | - Sommayya Aftab
- Dr. Sommayya Aftab, MBBS, FCPS. Senior Registrar (Pediatric Endocrinology), Department of Pediatric Endocrinology and Diabetes, The Children's Hospital & Institute of Child Health, Lahore, Pakistan
| | - Muhammad Yaqoob
- Dr. Muhammad Yaqoob, MBBS, MCPS, PhD. Assistant Professor (Clinical Genetics), Department of Genetics, The Children's Hospital & Institute of Child Health, Lahore, Pakistan
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Öcal G, Berberoğlu M, Sıklar Z, Aycan Z, Hacıhamdioglu B, Savas Erdeve Ş, Çamtosun E, Kocaay P, Ruhi HI, Kılıç BG, Tukun A. Clinical review of 95 patients with 46,XX disorders of sex development based on the new Chicago classification. J Pediatr Adolesc Gynecol 2015; 28:6-11. [PMID: 25444050 DOI: 10.1016/j.jpag.2014.01.106] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 01/27/2014] [Accepted: 01/31/2014] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE The aim of our study was to determine the etiologic distribution of 46,XX disorder of sexual development (DSD) according to the new DSD classification system and to evaluate the clinical features of this DSD subgroup in our patient cohort. PARTICIPANTS The evaluation criteria and clinical findings of 95 46,XX patients were described by clinical presentation, gonadal morphology, genital anatomy, associated dysmorphic features, presence during prenatal period with/without postnatal virilization, hormonal characteristics, and presence or absence of steroidogenic defects among 319 patients with DSD. RESULTS Types and ratios of each presentation of our 95 patients with 46,XX DSD were as follows: 82 had androgen excess (86.3%): (74 had classical congenital adrenal hyperplasia, 2 had CAH variant possibility of P450-oxidoreductase gene defect), 6 had disorders of ovarian development (6.3%): (1 patient had gonadal dysgenesis with virilization at birth with bilateral streak gonad, 4 patients had complete gonadal dysgenesis, and 1 patient had ovotesticular DSD) and 7 had other 46,XX DSD. Two sisters, who had 46,XX complete gonadal dysgenesis,were diagnosed with Perrault Syndrome with ovarian failure due to streak gonads and associated with sensorineural deafness. CONCLUSION 46,XX DSD are usually derived from intrauterine virilization and CAH is the most common cause of 46,XX DSD due to fetal androgen exposure.
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Affiliation(s)
- Gönül Öcal
- Pediatric Endocrinology, Department of Pediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey
| | - Merih Berberoğlu
- Pediatric Endocrinology, Department of Pediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Sıklar
- Pediatric Endocrinology, Department of Pediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey.
| | - Zehra Aycan
- Pediatric Endocrinology, Dr. Sami Ulus Children Hospital, Ankara, Turkey
| | - Bülent Hacıhamdioglu
- Pediatric Endocrinology, Department of Pediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey
| | - Şenay Savas Erdeve
- Pediatric Endocrinology, Department of Pediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey
| | - Emine Çamtosun
- Pediatric Endocrinology, Department of Pediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey
| | - Pınar Kocaay
- Pediatric Endocrinology, Department of Pediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey
| | - Hatice I Ruhi
- Medical Genetics, Department of Medical Genetics, Ankara University School of Medicine, Ankara, Turkey
| | - Birim G Kılıç
- Pediatric Psychiatry, Department of Pediatric Psychiatry, Ankara University School of Medicine, Ankara, Turkey
| | - Ajlan Tukun
- Medical Genetics, Department of Medical Genetics, Ankara University School of Medicine, Ankara, Turkey
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Ekenze SO, Nwangwu EI, Amah CC, Agugua-Obianyo NE, Onuh AC, Ajuzieogu OV. Disorders of sex development in a developing country: perspectives and outcome of surgical management of 39 cases. Pediatr Surg Int 2015; 31:93-9. [PMID: 25326123 DOI: 10.1007/s00383-014-3628-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Improvements in diagnostic testing and genital repair have significantly advanced the management of disorders of sex development (DSD). Challenges however, still exist in the management of DSD. This study evaluated the types, challenges of surgical management, and outcome of DSD in south-east Nigeria. METHODS Retrospective analysis of 39 children with DSD managed from January 2005 to December 2013 at the University of Nigeria Teaching Hospital, Enugu, Nigeria. RESULTS Types of DSD were: 46, XX DSD in 17 (43.6 %) cases; 46, XY DSD 16 (41 %); Ovotesticular DSD 5 (12.8 %); and one (2.6 %) 46, XY Ovotesticular DSD. Median age at definitive gender assignment was 3 years (range 2 months-14 years). Gender assignment was female for 20 (51.3 %; all 46, XX DSD, one each of 46, XY DSD, Ovotesticular DSD and 46, XY Ovotesticular DSD), and male for 19 (48.7 %; 15 of 46, XY DSD, 4 of Ovotesticular DSD). Eight cases reared as male before presentation required gender reassignment after evaluation and counselling. Genital repair was undertaken at mean age of 4.1 years (range 6 months-14 years). After average follow-up of 22.5 months (range 1 month-7 years), a total of eleven (28.2 %) developed procedure-related complications. Challenges were delayed diagnosis, inadequate diagnostic facilities, and need for gender reassignment. CONCLUSION There is a wide spectrum of DSD in our setting. Time to diagnosis, evaluation, and outcome may be improved by public enlightenment initiative, focused education of healthcare personnel and provision of relevant diagnostic facilities through enhanced funding and collaboration.
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Affiliation(s)
- S O Ekenze
- Sub-Department of Paediatric surgery, University of Nigeria Teaching Hospital Enugu, Enugu, 400001, Nigeria,
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Jaruratanasirikul S, Engchaun V. Management of children with disorders of sex development: 20-year experience in southern Thailand. World J Pediatr 2014; 10:168-74. [PMID: 23775676 DOI: 10.1007/s12519-013-0418-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2012] [Indexed: 10/26/2022]
Abstract
BACKGROUND Disorders of sex development (DSD) is a group of sexual differentiation disorders resulting in genital anomalies with defects in gonadal hormone synthesis and/or incomplete genital development. These conditions result in problems concerning the sex assignment of the child. This study aims to describe the clinical features, diagnosis and management of children with DSD in southern Thailand. METHODS The medical records of 117 pediatric patients diagnosed with DSD during the period of 1991-2011 were retrospectively reviewed. RESULTS Disorders of sex development were categorized into 3 groups: sex chromosome abnormalities (53.0%), 46,XX DSD (29.9%) and 46,XY DSD (17.1%). The two most common etiologies of DSD were Turner syndrome (36.8%) and congenital adrenal hyperplasia (29.9%). Ambiguous genitalia/intersex was the main problem in 46,XX DSD (94%) and 46,XY DSD (100%). Sex reassignment was done in 5 children (4.3%) at age of 3-5 years: from male to female in 4 children (1 patient with congenital adrenal hyperplasia, 1 patient with 45,X/46,XY DSD, and 2 patients with 46,XX ovotesticular DSD) and from female to male in 1 patient with 46,XX ovotesticular DSD. Of the total 20 children with 46,XY DSD, 16 (80%) were raised as females. CONCLUSION Management of DSD children has many aspects of concern. Sex assignment/reassignment depends on the phenotype (phallus size) of the external genitalia rather than the sex chromosome.
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Affiliation(s)
- Somchit Jaruratanasirikul
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Songkhla, Thailand,
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11
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Ocal G, Berberoğlu M, Sıklar Z, Ruhi HI, Tükün A, Camtosun E, Savaş Erdeve S, Hacıhamdioğlu B, Fitöz S. The clinical and genetic heterogeneity of mixed gonadal dysgenesis: does "disorders of sexual development (DSD)" classification based on new Chicago consensus cover all sex chromosome DSD? Eur J Pediatr 2012; 171:1497-502. [PMID: 22644991 DOI: 10.1007/s00431-012-1754-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 05/07/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED Clinical findings illustrate the wide spectrum of the phenotypic manifestations of 45,X/46,XY mosaicism in the sex chromosome disorders of sex differentiation (DSD). The objective of study is to evaluate the characteristics of 45,X/46,XY patients and questioning of their place within the DSD categorization. The clinical findings of 11 patients with 45,X/46,XY mosaicism are described including the presentation, gonadal morphology, genital anatomy, and the hormone levels among 285 patients with DSD evaluated. Sixty-seven patients were diagnosed with sex chromosome DSD (50 Turner, three Klinefelter, ten 45,X/46,XY gonadal disgenesis, one 45X/46,XY ovotesticular DSD, one 47,XYY ovotesticular DSD, and two 46,XX/46,XY ovotesticular DSD). The type and the percentage of patients with 45,X/46,XY mosaicism were as follows: Four cases of mix gonadal dysgenesis, four cases of partial gonadal dysgenesis, two cases of complete gonadal dysgenesis, one case of ovotesticular DSD. On the other hand, another patient that has 45,X/46,XX mosaicism was diagnosed with MGD with the presence of the streak gonad on the right side and the testis on the other side. CONCLUSION We suggest that sex chromosome DSD categorization can include 45,X/46,XY PGD and 45,X/46,XY CGD. Mixed gonadal dysgenesis may be also placed among the disorders of testicular differentiation of 46,XY DSD subdivision.
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Affiliation(s)
- Gönül Ocal
- Department of Pediatric Endocrinology, Medical School of Ankara University, Ankara, Turkey
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12
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Abstract
A number of factors have contributed to a sharp increase in the number of publications related to disorders of sex development (DSD) in the past 5 years, namely: the establishment of a consensus in 2006 about nomenclature, investigations and the need to treat these patients in a multidisciplinary setting; increase of the knowledge base about genetic mechanisms of normal and abnormal sex development; critical appraisal about the timing and nature of genital surgery in patients with DSD. Herein, the authors present a comprehensive review with up-to-date data about the approach to the newborn with ambiguous genitalia as well as the diagnosis and management of the most common DSD.
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Affiliation(s)
- Rodrigo L P Romao
- Division of Urology, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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13
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Abstract
Disorders of sex development (DSD) with or without ambiguous genitalia require medical attention to reach a definite diagnosis. Advances in identification of molecular causes of abnormal sex, heightened awareness of ethical issues and this necessitated a re-evaluation of nomenclature. The term DSD was proposed for congenital conditions in which chromosomal, gonadal or anatomical sex is atypical. In general, factors influencing sex determination are transcriptional regulators, whereas factors important for sex differentiation are secreted hormones and their receptors. The current intense debate on the management of patients with intersexuality and related conditions focus on four major issues: 1) aetiological diagnosis, 2) assignment of gender, 3) indication for and timing of genital surgery, 4) the disclosure of medical information to the patient and his/her parents. The psychological and social implications of gender assignment require a multidisciplinary approach and a team which includes ageneticist, neonatologist, endocrinologist, gynaecologist, psychiatrist, surgeon and a social worker. Each patient should be evaluated individually by multidisciplinary approach.
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Affiliation(s)
- Gönül Öçal
- Ankara University School of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey.
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