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Ovidiu B, Marcu DR, Mischianu DLD, Poiana C, Diaconu CC, Bungau SG, Tit DM, Cumpanas A, Bohiltea R. The challenges of androgen insensitivity syndrome. Arch Med Sci 2022; 18:881-889. [PMID: 35832699 PMCID: PMC9266792 DOI: 10.5114/aoms/125584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/21/2020] [Indexed: 11/17/2022] Open
Abstract
Androgen insensitivity syndrome (AIS) is an X-linked recessive genetic syndrome that occurs as result of an androgen receptor mutation; it affects the normal masculinization process in chromosomal male patients. More than 900 androgen receptor mutations that can lead to AIS have been identified. The complete androgen insensitivity is characterized by a total lack of response to androgens, usually in patients with 46XY karyotype but with feminine phenotype. Primary amenorrhoea and inguinal swellings in female patients are the main signs that could raise suspicion for this syndrome. Patients with partial androgen insensitivity have ambiguous genitalia at birth and gynecomastia during puberty, whereas those with mild androgen insensitivity present a normal male phenotype but altered spermatogenesis during adulthood and pubertal gynecomastia. The diagnosis of AIS often proves to be a challenge; its management is complex and requires a multidisciplinary approach to meet decision-making challenges in sex assignment, fertility and timing of gonadectomy, psychological outcomes and genetic counselling.
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Affiliation(s)
- Bratu Ovidiu
- Central Military Hospital Bucharest, Romania
- University of Medicine and Pharmacy, Bucharest, Romania
| | - Dragos R. Marcu
- Central Military Hospital Bucharest, Romania
- University of Medicine and Pharmacy, Bucharest, Romania
| | - Dan L. D. Mischianu
- Central Military Hospital Bucharest, Romania
- University of Medicine and Pharmacy, Bucharest, Romania
| | - Catalina Poiana
- University of Medicine and Pharmacy, Bucharest, Romania
- Parhon Hospital, Romania
| | - Camelia C. Diaconu
- University of Medicine and Pharmacy, Bucharest, Romania
- Floreasca Emergency Clinical Hospital, Romania
| | | | - Delia M. Tit
- Faculty of Medicine and Pharmacy, University of Oradea, Romania
| | - Alin Cumpanas
- University of Medicine and Pharmacy, Timisoara, Romania
| | - Roxana Bohiltea
- University of Medicine and Pharmacy, Bucharest, Romania
- University Emergency Hospital of Bucharest, Romania
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Malcher A, Jedrzejczak P, Stokowy T, Monem S, Nowicka-Bauer K, Zimna A, Czyzyk A, Maciejewska-Jeske M, Meczekalski B, Bednarek-Rajewska K, Wozniak A, Rozwadowska N, Kurpisz M. Novel Mutations Segregating with Complete Androgen Insensitivity Syndrome and their Molecular Characteristics. Int J Mol Sci 2019; 20:ijms20215418. [PMID: 31671693 PMCID: PMC6861889 DOI: 10.3390/ijms20215418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 01/12/2023] Open
Abstract
We analyzed three cases of Complete Androgen Insensitivity Syndrome (CAIS) and report three hitherto undisclosed causes of the disease. RNA-Seq, Real-timePCR, Western immunoblotting, and immunohistochemistry were performed with the aim of characterizing the disease-causing variants. In case No.1, we have identified a novel androgen receptor (AR) mutation (c.840delT) within the first exon in the N-terminal transactivation domain. This thymine deletion resulted in a frameshift and thus introduced a premature stop codon at amino acid 282. In case No.2, we observed a nonsynonymous mutation in the ligand-binding domain (c.2491C>T). Case No.3 did not reveal AR mutation; however, we have found a heterozygous mutation in CYP11A1 gene, which has a role in steroid hormone biosynthesis. Comparative RNA-Seq analysis of CAIS and control revealed 4293 significantly deregulated genes. In patients with CAIS, we observed a significant increase in the expression levels of PLCXD3, TM4SF18, CFI, GPX8, and SFRP4, and a significant decrease in the expression of SPATA16, TSACC, TCP10L, and DPY19L2 genes (more than 10-fold, p < 0.05). Our findings will be helpful in molecular diagnostics of patients with CAIS, as well as the identified genes could be also potential biomarkers for the germ cells differentiation process.
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Affiliation(s)
- Agnieszka Malcher
- Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland.
| | - Piotr Jedrzejczak
- Division of Infertility and Reproductive Endocrinology, Department of Gynecology, Obstetrics and Gynecological Oncology, Poznan University of Medical Sciences, 60-535 Poznan, Poland.
| | - Tomasz Stokowy
- Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Soroosh Monem
- Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland.
| | | | - Agnieszka Zimna
- Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland.
| | - Adam Czyzyk
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland.
| | - Marzena Maciejewska-Jeske
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland.
| | - Blazej Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland.
| | | | - Aldona Wozniak
- Department of Clinical Pathology, Poznan University of Medical Sciences, 60-355 Poznan, Poland.
| | - Natalia Rozwadowska
- Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland.
| | - Maciej Kurpisz
- Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland.
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Maciejewska-Jeske M, Rojewska-Madziala P, Broda K, Drabek K, Szeliga A, Czyzyk A, Malinger S, Kostrzak A, Podfigurna A, Bala G, Meczekalski B, Malcher A, Kurpisz M. New mutation causing androgen insensitivity syndrome - a case report and review of literature. Gynecol Endocrinol 2019; 35:294-297. [PMID: 30449224 DOI: 10.1080/09513590.2018.1529160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Androgen insensitivity syndrome (AIS) is a congenital disorder in which a defect in the androgen receptor (AR) gene leads to cellular resistance to androgens. Defects in the AR gene, located on the X chromosome, result in the development of a feminine phenotype in chromosomally male (46, XY) individuals. In this case report, we present a 44 years old patient with complete androgen insensitivity syndrome (CAIS) initially presenting with primary amenorrhea. The patient underwent a full clinical evaluation, revealing hypoplastic vagina and a lack of uterus and ovaries. Hormonal evaluation revealed markedly elevated testosterone, FSH, and LH serum concentrations. Diagnostic imaging, including pelvic MRI, confirmed the presence of two solid masses in the inguinal canals (right 26 × 13 mm, left 25 × 15 mm). The patient underwent genetic testing, revealing a 46 XY karyotype and an as of yet unprecedented androgen receptor mutation. The type of the mutation was a single-base exchange - the substitution from cytosine to thymine in chromosome X:66942710 position (referred to human reference genome GRCh37), which has resulted in an amino acid changes from leucine (CTT) to phenyloalanine (TTT) in ligand-binding domain.
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Affiliation(s)
- Marzena Maciejewska-Jeske
- a Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznan , Poland
| | | | - Karolina Broda
- b Students Scientific Society of the Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznan , Poland
| | - Karolina Drabek
- b Students Scientific Society of the Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznan , Poland
| | - Anna Szeliga
- a Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznan , Poland
| | - Adam Czyzyk
- a Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznan , Poland
| | - Stanislaw Malinger
- c Department of General and Endocrine Surgery and Gastroenterological Oncology , Poznan University of Medical Sciences , Poznan , Poland
| | - Anna Kostrzak
- a Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznan , Poland
| | - Agnieszka Podfigurna
- a Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznan , Poland
| | - Gregory Bala
- b Students Scientific Society of the Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznan , Poland
| | - Blazej Meczekalski
- a Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznan , Poland
| | - Agnieszka Malcher
- d Department of Reproductive Biology and Stem Cells , Institute of Human Genetics, Polish Academy of Sciences , Poznan , Poland
| | - Maciej Kurpisz
- d Department of Reproductive Biology and Stem Cells , Institute of Human Genetics, Polish Academy of Sciences , Poznan , Poland
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