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Barki D, Manayath N, Vatsa BS, Venkatanarasimhan N S, Vishnuvardhana G V, Achar S, Bhat B. 'Testicular masquerade': a case report of testicular malignancy with persistent Müllerian duct syndrome and transverse testicular ectopia. Ann R Coll Surg Engl 2024; 106:466-470. [PMID: 38038079 PMCID: PMC11060860 DOI: 10.1308/rcsann.2023.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 12/02/2023] Open
Abstract
Persistent Müllerian duct syndrome (PMDS) is a rare sexual development disorder. It is even more rarely associated with transverse testicular ectopia (TTE), a rare form of testicular ectopia, in which both testes descend through a single inguinal canal and are present in the same hemiscrotum. PMDS with TTE is associated with 18%-33% malignant transformation. Here we report the case of a 48-year-old man who presented with a large right inguinoscrotal swelling and on evaluation was found to have a large right testicular mass with complete right inguinal hernia, undescended left testis and a central abdominal mass. On evaluation with contrast-enhanced computed tomography abdomen and pelvis and image-guided biopsy he was diagnosed with mixed germ cell tumour of the right testis (predominantly a seminoma) with a retroperitoneal nodal mass and absent left testis, for which he received chemotherapy. Post-chemotherapy he underwent surgery and was diagnosed intraoperatively with PMDS along with TTE and testicular malignancy arising from the ectopic left testis. Postoperative recovery and follow-up were uneventful. Most cases of PMDS are diagnosed early in life. They present clinically with unilateral or bilateral undescended testis with inguinal hernia. In adults, PMDS is usually associated with male infertility. However, TTE is associated with an increased risk of testicular tumours if undiagnosed until adulthood. In adults PMDS with TTE is usually an intraoperative finding and is commonly associated with malignancy in the ectopic/undescended testis.
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Affiliation(s)
- D Barki
- Bangalore Baptist Hospital, India
| | | | - BS Vatsa
- Bangalore Baptist Hospital, India
| | | | | | - S Achar
- Bangalore Baptist Hospital, India
| | - B Bhat
- Bangalore Baptist Hospital, India
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Wei X, Li S, He Y. NR5A1-related 46,XY partial gonadal dysgenesis: A case report and literature review. Medicine (Baltimore) 2023; 102:e36725. [PMID: 38206718 PMCID: PMC10754607 DOI: 10.1097/md.0000000000036725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 09/26/2023] [Accepted: 11/29/2023] [Indexed: 01/13/2024] Open
Abstract
RATIONALE Disorders/differences of sex development (DSD) include a diverse group of congenital conditions in which the development of chromosomal, gonadal, or anatomical sex is discordant. It involves several variant genes, and one of them is NR5A1. NR5A1 encodes a signal transduction regulator in the hypothalamic-pituitary-gonadal and hypothalamic-pituitary-adrenal pathway, and pathogenic mutation in this gene is a cause of 46,XY DSD. PATIENT CONCERNS A 12-year-old individual raised as a girl was admitted to the hospital due to hirsutism and a deep voice that began at 11 years old. The individual exhibited testicular hypoplasia, clitoral hypertrophy, and female external genitalia. DIAGNOSES The patient was diagnosed 46,XY partial gonadal dysgenesis. The cytogenetics revealed a 46,XY karyotype and DNA sequencing shown a variant in NR5A1. Pelvic magnetic resonance imaging showed absence of uterus and ovaries. The abdominopelvic ultrasound revealed bilateral testicle in bilateral groin. Pathology confirmed testes dysgenesis. INTERVENTIONS The patient underwent bilateral orchiectomy at age 12 years and was given a feminizing hormonal treatment of 0.5 mg/day of estradiol valerate tablets. OUTCOMES The patient recovered well after surgery and hormonal treatment and had a regression in hirsutism and clitoromegaly. LESSONS 46,XY DSD is a rare disease that the development of chromosomal, gonadal, or anatomical sex is discordant, when diagnosed 46,XY DSD, the identification of an NR5A1 variant should be considered.
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Affiliation(s)
- Xianzhen Wei
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University; Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Nanning city, Guangxi, China
| | - Shan Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University; Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Nanning city, Guangxi, China
| | - Yu He
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University; Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Nanning city, Guangxi, China
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Sun Z, Yang M, Zhuang Y, Duan S. Research progress on the pathogenesis of pediatric transverse testicular ectopia with persistent Mullerian duct syndrome. Asian J Surg 2023; 46:5897-5898. [PMID: 37734984 DOI: 10.1016/j.asjsur.2023.08.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023] Open
Affiliation(s)
- Zongbo Sun
- Medical School, LiaoCheng University, No. 1 Hunan Road, Liaocheng, 252000, Shandong, China
| | - Min Yang
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Shantou, 515041, Guangdong, China
| | - Yangmu Zhuang
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Shantou, 515041, Guangdong, China
| | - Shouxing Duan
- Department of Pediatric Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), No. 89 Taoyuan Road, Shenzhen, 518052, Guangdong, China.
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Fatima N, Kiran Z, Shabbir KU, Baloch AA. Persistent Müllerian Duct Syndrome Diagnosed Incidentally: A Case Report. J PAK MED ASSOC 2023; 73:2280-2283. [PMID: 38013548 DOI: 10.47391/jpma.9172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Persistent Müllerian Duct syndrome is a rare male disorder of sexual development. The phenotypically and genotypically male patient presents with female internal organs (i.e., uterus, cervix, fallopian tubes and upper part of vagina) due to deficiency of anti-mullerian hormone or insensitivity of tissues to Anti Mullerian Hormone. We present a 19 year old male who came with complaint of right iliac fossa pain. He was investigated for acute appendicitis and on imaging, he was diagnosed to have bilateral cryptorchidism with rudimentary uterus. Computed tomography followed by pelvic ultrasonography was done which indicated two testes in abdomen and a soft tissue density structure, identified as a rudimentary uterus located posterior to the urinary bladder. CT scan findings were further confirmed by magnetic resonance imaging pelvis. A trial of stepwise orchidopexy followed by orchidectomy with removal of rudimentary uterus was performed laparoscopically. Additionally, he was counselled for long term sex hormone replacement and reproductive failure in future.
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Affiliation(s)
- Nazish Fatima
- Dow University of Health Sciences, Karachi, Pakistan
| | - Zareen Kiran
- Dow University of Health Sciences, Karachi, Pakistan
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Guo Q, Zhong WW, Lai HJ, Ye L, Zhang YF, Li JT, Qiu JG, Wang DJ. Targeted Next-Generation Sequencing for the Diagnosis of Gene Variants in Patients with 46,XY Disorder of Sex Development. Sex Dev 2023; 17:26-31. [PMID: 36689917 DOI: 10.1159/000528916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 01/02/2023] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Disorders of sex development (DSDs) are congenital abnormalities in which chromosomal, gonadal, and anatomical sex development are atypical. One of these disorders, 46,XY DSD, is particularly difficult to diagnose and manage because its etiology and clinical phenotypes are highly heterogeneous. METHODS We used a gene panel containing 141 genes implicated in DSDs to perform targeted next-generation sequencing (NGS) in 50 patients with 46,XY DSD. RESULTS Gene variants were detected in 23 patients (46%). Among them, 13 patients had previously reported pathogenic or likely pathogenic variants, 9 patients had novel variants, and 1 patient had a previously reported variant of uncertain significance. Three of the novel variants were pathogenic, and the remaining were variants of uncertain significance; therefore, 16 patients had pathogenic or likely pathogenic variants according to ACMG guidelines, and the overall diagnostic rate of 46,XY DSD was 32%. The most common gene variants were SRD5A2 variants, followed by the AR variant. In addition, we analyzed the association between gene variants and clinical phenotypes. Most patients presented with multiple DSD phenotypes (i.e., two or more DSD phenotypes were observed, such as micropenis, hypospadias, and cryptorchidism), but the phenotype with the highest diagnostic rate was micropenis. CONCLUSION Our results indicate that targeted NGS can effectively detect pathogenic gene variants in patients with 46,XY DSD.
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Affiliation(s)
- Qiang Guo
- Department of Urology, The Sixth Affiliated Hospital , Sun Yat-sen University, Guangzhou, China
| | - Wen Wen Zhong
- Department of Urology, The Sixth Affiliated Hospital , Sun Yat-sen University, Guangzhou, China
| | - Hua Jian Lai
- Department of Urology, The Sixth Affiliated Hospital , Sun Yat-sen University, Guangzhou, China
| | - Lei Ye
- Department of Urology, The Sixth Affiliated Hospital , Sun Yat-sen University, Guangzhou, China
| | - Yi Fei Zhang
- Department of Urology, The Sixth Affiliated Hospital , Sun Yat-sen University, Guangzhou, China
| | - Jun Tao Li
- Department of Urology, The Sixth Affiliated Hospital , Sun Yat-sen University, Guangzhou, China
| | - Jian Guang Qiu
- Department of Urology, The Sixth Affiliated Hospital , Sun Yat-sen University, Guangzhou, China
| | - De Juan Wang
- Department of Urology, The Sixth Affiliated Hospital , Sun Yat-sen University, Guangzhou, China
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Mattone MC, Lobo de la Vega MV, Redondo EJ, D'Alessandro P, Perez Garrido N, Galluzzo ML, Costanzo M, Zaidman V, Lazzati JM, Berensztein E, Ramirez P, Marino R, Belgorosky A, Ciaccio M, Bailez M, Guercio G. A Surgical and Clinical Approach to Persistent Müllerian Duct Syndrome: Laparoscopic, Histological, and Molecular Findings. Sex Dev 2023; 17:1-7. [PMID: 36626890 DOI: 10.1159/000526992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/06/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Persistent müllerian duct syndrome (PMDS) is characterized by the persistence of müllerian duct derivatives in otherwise normally virilized 46,XY males. Biallelic mutations of the anti-müllerian hormone (AMH) and AMH receptor type 2 (AMHR2) genes lead to PMDS type 1 and 2, respectively. AIM The aims of the study were to report the clinical, hormonal, and genetic findings in a patient with PMDS and discuss surgical strategies to achieve successful orchidopexy. RESULTS A 4-year-old boy was evaluated after the incidental finding of müllerian derivates during laparoscopy for nonpalpable gonads. Karyotype was 46,XY and laboratory tests revealed normal serum gonadotropin and androgen levels but undetectable serum AMH levels. PMDS was suspected. Molecular analysis revealed a novel variant c.902_929del in exon 5 and a previously reported mutation (c.367C>T) in exon 1 of the AMH gene. Successful orchidopexy was performed in two sequential surgeries in which the müllerian duct structure was preserved and divided to protect the vascular supply to the gonads. Histological evaluation of the testicular biopsy showed mild signs of dysgenesis. Doppler ultrasound showed blood flow in both testes positioned in the scrotum 1.5 years after surgery. CONCLUSION PMDS is a rare entity that requires a high index of suspicion (from surgeons) when evaluating a patient with bilateral cryptorchidism. Surgical treatment is challenging and long-term follow-up is essential. Histological evaluation of the testis deserves further investigation.
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Affiliation(s)
- María Celeste Mattone
- Endocrinology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina
| | | | - Emiro J Redondo
- Surgery Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Pablo D'Alessandro
- Surgery Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Natalia Perez Garrido
- Endocrinology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - María Laura Galluzzo
- Pathology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Mariana Costanzo
- Endocrinology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Verónica Zaidman
- Endocrinology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Juan Manuel Lazzati
- Endocrinology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Esperanza Berensztein
- Endocrinology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Pablo Ramirez
- Endocrinology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Roxana Marino
- Endocrinology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Alicia Belgorosky
- Endocrinology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina
| | - Marta Ciaccio
- Endocrinology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Marcela Bailez
- Surgery Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Gabriela Guercio
- Endocrinology Department, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina
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Koizumi M, Ida S, Etani Y, Kawai M. Evaluations for Wilms tumor and late-onset nephrotic syndrome in 46,XY DSD. Pediatr Int 2023; 65:e15418. [PMID: 36382929 DOI: 10.1111/ped.15418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Mikiko Koizumi
- Department of Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Japan
- Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | - Shinobu Ida
- Department of Laboratory Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Yuri Etani
- Department of Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Masanobu Kawai
- Department of Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Japan
- Department of Bone and Mineral Research, Research Institute, Osaka Women's and Children's Hospital, Izumi, Japan
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Maheswara Y, Meshram R. Persistent müllerian duct syndrome: a rare clinical image. Pan Afr Med J 2023; 44:45. [PMID: 37070026 PMCID: PMC10105332 DOI: 10.11604/pamj.2023.44.45.38847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023] Open
Affiliation(s)
- Yarraiahgari Maheswara
- Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Health and Educational Research, Sawangi Meghe, Wardha, Maharashtra State, India
- Corresponding author: Yarraiahgari Maheswara, Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Health and Educational Research, Sawangi Meghe, Wardha, Maharashtra State, India.
| | - Revat Meshram
- Department of Paediatrics, Datta Meghe Institute of Higher Education and Research, Sawangi, Wardha, Maharashtra, India
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Yang M, Lin X, Liu Z, Zhang P, Xiao W, Chen Y, Chen Y, Zhuang Y, Zheng L, Duan S. Transverse testicular ectopia with persistent Mullerian duct syndrome: Report and review of two cases. Andrologia 2022; 54:e14637. [PMID: 36357339 DOI: 10.1111/and.14637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/03/2022] [Accepted: 10/28/2022] [Indexed: 11/12/2022] Open
Abstract
Transverse testicular ectopia is a rare anomaly characterized by both testes descending through a single inguinal canal. The objective of this study was to investigate the pathogenesis, diagnosis, and treatment of transverse testicular ectopia (TTE) with persistent Mullerian duct syndrome (PMDS), and to deepen the understanding of the disease in clinical. A retrospective analysis of the clinical manifestation, diagnosis, and treatment of two children suffering from TTE with PMDS was conducted. Previous studies on the characteristics, diagnosis, and treatment of this disease were reviewed. The two patients were treated with laparoscopy-assisted transseptal orchidopexy-inguinal evaluation. After the surgery, the two patients recovered well. The follow-up visits were done 3 months after the operation. An ultrasound examination confirmed that the two patients had testes in the orthotopic position and normal size. TTE with PMDS is an exceedingly rare disease. The patients manifested cryptorchidism on one side; contralateral inguinal hernia was suspected. Detailed physical and ultrasound examinations before the operation are the key to the early diagnosis of TTE. Laparoscopic evaluation is helpful for the diagnosis and finding of other abnormalities. Surgical treatment is the only method to cure the disease; long-term follow-up is needed after TTE operation.
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Affiliation(s)
- Min Yang
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xiaobin Lin
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Zhijun Liu
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Peijian Zhang
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Wang Xiao
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yingchun Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yiyi Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yangmu Zhuang
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Lian Zheng
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Shouxing Duan
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- Department of Pediatric Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong, China
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Gomes NL, Batista RL, Nishi MY, Lerário AM, Silva TE, de Moraes Narcizo A, Benedetti AFF, de Assis Funari MF, Faria Junior JA, Moraes DR, Quintão LML, Montenegro LR, Ferrari MTM, Jorge AA, Arnhold IJP, Costa EMF, Domenice S, Mendonca BB. Contribution of Clinical and Genetic Approaches for Diagnosing 209 Index Cases With 46,XY Differences of Sex Development. J Clin Endocrinol Metab 2022; 107:e1797-e1806. [PMID: 35134971 DOI: 10.1210/clinem/dgac064] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Received: 11/15/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Massively parallel sequencing (MPS) technologies have emerged as a first-tier approach for diagnosing several pediatric genetic syndromes. However, MPS has not been systematically integrated into the diagnostic workflow along with clinical/biochemical data for diagnosing 46,XY differences of sex development (DSD). OBJECTIVE To analyze the contribution of phenotypic classification either alone or in association with genetic evaluations, mainly MPS, for diagnosing a large cohort of 46,XY DSD patients. DESIGN/PATIENTS 209 nonsyndromic 46,XY DSD index cases from a Brazilian DSD center were included. Patients were initially classified into 3 subgroups according to clinical and biochemical data: gonadal dysgenesis (GD), disorders of androgen secretion/action, and DSD of unknown etiology. Molecular genetic studies were performed by Sanger sequencing and/or MPS. RESULTS Clinical/biochemical classification into either GD or disorders of hormone secretion/action was obtained in 68.4% of the index cases. Among these, a molecular diagnosis was obtained in 36% and 96.5%, respectively. For the remainder 31.6% classified as DSD of clinically unknown etiology, a molecular diagnosis was achieved in 31.8%. Overall, the molecular diagnosis was achieved in 59.3% of the cohort. The combination of clinical/biochemical and molecular approaches diagnosed 78.9% of the patients. Clinical/biochemical classification matched with the genetic diagnosis in all except 1 case. DHX37 and NR5A1 variants were the most frequent genetic causes among patients with GD and DSD of clinical unknown etiology, respectively. CONCLUSIONS The combination of clinical/biochemical with genetic approaches significantly improved the diagnosis of 46,XY DSD. MPS potentially decreases the complexity of the diagnostic workup as a first-line approach for diagnosing 46,XY DSD.
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Affiliation(s)
- Nathalia Lisboa Gomes
- Unidade de Endocrinologia do Desenvolvimento/ LIM42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Unidade de Adrenal, Serviço de Endocrinologia, Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
| | - Rafael Loch Batista
- Unidade de Endocrinologia do Desenvolvimento/ LIM42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Mirian Y Nishi
- Unidade de Endocrinologia do Desenvolvimento/ LIM42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Antônio Marcondes Lerário
- Division of Metabolism, Department of Internal Medicine, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Thatiana E Silva
- Unidade de Endocrinologia do Desenvolvimento/ LIM42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Amanda de Moraes Narcizo
- Laboratório de Sequenciamento em Larga Escala (SELA), Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil
| | - Anna Flávia Figueredo Benedetti
- Laboratório de Sequenciamento em Larga Escala (SELA), Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil
| | - Mariana Ferreira de Assis Funari
- Unidade de Endocrinologia do Desenvolvimento/ LIM42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Antônio Faria Junior
- Unidade de Endocrinologia do Desenvolvimento/ LIM42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Daniela Rodrigues Moraes
- Unidade de Endocrinologia do Desenvolvimento/ LIM42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lia Mesquita Lousada Quintão
- Unidade de Endocrinologia do Desenvolvimento/ LIM42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luciana Ribeiro Montenegro
- Unidade de Endocrinologia do Desenvolvimento/ LIM42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Maria Teresa Martins Ferrari
- Unidade de Endocrinologia do Desenvolvimento/ LIM42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alexander A Jorge
- Unidade de Endocrinologia do Desenvolvimento/ LIM42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Unidade de Endocrinologia Genética, Laboratório de Endocrinologia Celular e Molecular LIM25, Disciplina de Endocrinologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ivo J P Arnhold
- Unidade de Endocrinologia do Desenvolvimento/ LIM42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Elaine Maria Frade Costa
- Unidade de Endocrinologia do Desenvolvimento/ LIM42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Sorahia Domenice
- Unidade de Endocrinologia do Desenvolvimento/ LIM42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Berenice Bilharinho Mendonca
- Unidade de Endocrinologia do Desenvolvimento/ LIM42, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Abstract
CONTEXT Anti-Mullerian hormone (AMH) was originally described in the context of sexual differentiation in the male fetus but has gained prominence now as a marker of ovarian reserve and fertility in females. In this mini-review, we offer an updated synopsis on AMH and its clinical utility in pediatric patients. DESIGN AND RESULTS A systematic search was undertaken for studies related to the physiology of AMH, normative data, and clinical role in pediatrics. In males, AMH, secreted by Sertoli cells, is found at high levels prenatally and throughout childhood and declines with progression through puberty to overlap with levels in females. Thus, serum AMH has clinical utility as a marker of testicular tissue in males with differences in sexual development and cryptorchidism and in the evaluation of persistent Mullerian duct syndrome. In females, serum AMH has been used as a predictive marker of ovarian reserve and fertility, but prepubertal and adolescent AMH assessments need to be interpreted cautiously. AMH is also a marker of tumor burden, progression, and recurrence in germ cell tumors of the ovary. CONCLUSIONS AMH has widespread clinical diagnostic utility in pediatrics but interpretation is often challenging and should be undertaken in the context of not only age and sex but also developmental and pubertal stage of the child. Nonstandardized assays necessitate the need for assay-specific normative data. The recognition of the role of AMH beyond gonadal development and maturation may usher in novel diagnostic and therapeutic applications that would further expand its utility in pediatric care.
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Affiliation(s)
- Roopa Kanakatti Shankar
- Division of Endocrinology, Children’s National Hospital, Washington DC, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Correspondence: Roopa Kanakatti Shankar, MBBS, MS, George Washington University School of Medicine, Endocrinologist, Children’s National Hospital, 111 Michigan Ave NW, Washington DC, 20010, USA.
| | - Tazim Dowlut-McElroy
- Pediatric and Adolescent Gynecology Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | - Andrew Dauber
- Division of Endocrinology, Children’s National Hospital, Washington DC, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Veronica Gomez-Lobo
- Pediatric and Adolescent Gynecology Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
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12
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Lu W, Zhang T, Zhang L, Wang X, Lv S, Wang J, Ye L, Xiao Y, Dong Z, Wang W, Sun S, Li C, Hu R, Ning G, Ma X. Clinical characteristics of a male child with non-classic lipoid congenital adrenal hyperplasia and literature review. Front Endocrinol (Lausanne) 2022; 13:947762. [PMID: 36407315 PMCID: PMC9666400 DOI: 10.3389/fendo.2022.947762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/12/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Lipoid congenital adrenal hyperplasia (LCAH) is a rare and severe disorder that is caused by mutations in the steroidogenic acute regulatory protein (StAR). Non-classic LCAH is defined as late-onset glucocorticoid deficiency and even complete male external genitalia in 46,XY individuals. However, to date, few cases of non-classic LCAH have been reported. METHODS It was attempted to describe the clinical characteristics of a male child with complete male external genitalia in terms of age of onset, adrenal function, and biochemical indicators. Previously reported cases were also reviewed to investigate the relationship of age of onset with enzymatic activity in non-classic LCAH. RESULTS The patient with complete male external genitalia was diagnosed with non-classic LCAH, in which the reason for his referral to a local hospital at the of age 1.25 years was progressive skin hyperpigmentation, and plasma adrenocorticotropic hormone (ACTH) level was elevated to higher than 1,250 pg/ml. The compound heterozygous mutations c.772C>T/c.562C>T in STAR gene were identified via genetic testing. The literature review resulted in identification of 47 patients with non-classic LCAH from 36 families. The mutational analysis showed that c.562C>T mutation was prevalent in patients with non-classic LCAH, accounting for 37.2% of the total mutant alleles, which could reflect the founder effect on the non-classic LCAH population. In total, 28 46,XY patients were reported, including 22 (78.5%) cases with complete male external genitalia and six (21.5%) cases with different degrees of hypospadias. CONCLUSION The clinical phenotypes of non-classic LCAH are highly variable. Routine physical examination, laboratory measurement, genetic testing, and, importantly, enzymatic activity assay may facilitate the early diagnosis of non-classic LCAH. The age of primary adrenal insufficiency (PAI) onset may not be a diagnostic basis for non-classic LCAH, and enzymatic activity assay determination may be more effective.
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Affiliation(s)
- Wenli Lu
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingting Zhang
- Department of Pediatric Genetic and Metabolic Endocrinology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lidan Zhang
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xueqing Wang
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sheng Lv
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junqi Wang
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Ye
- Department of Endocrine and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Xiao
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiya Dong
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Wang
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuoyue Sun
- Department of Endocrine and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuanyin Li
- Cancer Center, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Chuanyin Li, ; Ronggui Hu, ; Guang Ning, ; Xiaoyu Ma,
| | - Ronggui Hu
- Cancer Center, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Chuanyin Li, ; Ronggui Hu, ; Guang Ning, ; Xiaoyu Ma,
| | - Guang Ning
- Department of Endocrine and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Chuanyin Li, ; Ronggui Hu, ; Guang Ning, ; Xiaoyu Ma,
| | - Xiaoyu Ma
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Chuanyin Li, ; Ronggui Hu, ; Guang Ning, ; Xiaoyu Ma,
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13
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Tian HJ, Wu DH, Ru W, Wu DW, Tao C, Chen GJ, Yuan JN, Fu JF, Tang DX. Surgical management and molecular diagnosis of persistent Müllerian duct syndrome in Chinese patients. Asian J Androl 2022; 24:78-84. [PMID: 34810374 PMCID: PMC8788598 DOI: 10.4103/aja202175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/31/2021] [Accepted: 08/26/2021] [Indexed: 11/07/2022] Open
Abstract
Persistent Müllerian duct syndrome (PMDS) is a rare clinically and genetically overlapping disorder caused by mutations in the anti-Müllerian hormone (AMH) gene or the anti-Müllerian hormone receptor type 2 (AMHR2) gene. Affected individuals present uterus and tubes in normally virilized males and are discovered unexpectedly during other surgeries. Since it is rare and complex, a definitive clinical diagnosis can be missed, and there are no guidelines regarding how to deal with the uterus. In the present study, exome sequencing and Sanger verification were performed for causal variants in 12 PMDS patients. Preoperative diagnoses were made by positive exome sequencing in 8 patients. Of them, 7 patients evoked on the basis of ultrasound indicating bilateral testes on the same side of the body. Twelve different AMH variants (2 frameshift/nonsense, 1 deletion, 8 missense, and 1 in-frame) in 9 patients and 6 different AMHR2 variants (5 missense and 1 splicing) in 3 patients were identified. Seven variants were classified as "pathogenic" or "likely pathogenic", and 4 of them were novel. All but two patients with AMH defects showed low serum AMH concentrations, but all patients with AMHR2 defects showed elevated AMH levels. During surgery, an abnormal vas deferens was observed in half of the patients. Eight patients underwent orchidopexy with uterine preservation. Of them, 2 patients presented complications including irreducible cryptorchidism, and 3 patients developed Müllerian remnant cysts. Three patients underwent subtotal hysterectomy. Of them, one patient had complication of injury to the vas deferens, and one had hemorrhage after operation. This is the first report of PMDS involving a large Chinese population. The present study not only expands the variation spectrum but also provides clinical experience about the management of the uterus.
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Affiliation(s)
- Hong-Juan Tian
- Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - De-Hua Wu
- Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Wei Ru
- Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Ding-Wen Wu
- Department of Genetics and Metabolism, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Chang Tao
- Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Guang-Jie Chen
- Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Jin-Na Yuan
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Jun-Fen Fu
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Da-Xing Tang
- Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
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14
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Gul UJ, Hussain Zaidi SA, Medhat N, Ahmad D, Khawaja FG. Persistent Mullerian Duct Syndrome. J Ayub Med Coll Abbottabad 2021; 33(Suppl 1):S818-S822. [PMID: 35077632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Persistent Mullerian Duct Syndrome is extremely rare. Our patient, a 32 years old male, with history of orchidectomy presented with mass abdomen. He was initially diagnosed with seminoma and subsequently treated with chemotherapy. Biopsy of the mass showed germ cell tumour and MRI abdomen revealed female rudimentary organs confirmed on per operative and later on histopathology. Karyotype was 46 XY.
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Affiliation(s)
- Uzma Javed Gul
- Department of General Surgery, Combined Military Hospital, Rawalpindi, Pakistan
| | | | - Naila Medhat
- Department of General Surgery, Combined Military Hospital, Rawalpindi, Pakistan
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15
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Luna SE, Wegner DJ, Gale S, Yang P, Hollander A, St Dennis-Feezle L, Nabhan ZM, Ory DS, Cole FS, Wambach JA. Whole exome sequencing and functional characterization increase diagnostic yield in siblings with a 46, XY difference of sexual development (DSD). J Steroid Biochem Mol Biol 2021; 212:105908. [PMID: 33984517 PMCID: PMC8725205 DOI: 10.1016/j.jsbmb.2021.105908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 11/23/2022]
Abstract
Pathogenic biallelic variants in HSD17B3 result in 17β-hydroxysteroid dehydrogenase 3 (17β-HSD3) deficiency, variable disruption of testosterone production, and phenotypic diversity among 46, XY individuals with differences of sexual development (DSDs). We performed quad whole exome sequencing (WES) on two male siblings with microphallus, perineal hypospadias, and bifid scrotum and their unaffected parents. Both male siblings were compound heterozygous for a rare pathogenic HSD17B3 variant (c.239 G > A, p.R80Q) previously identified among individuals with 17β-HSD3 deficiency and a HSD17B3 variant (c.641A > G, p.E214 G) of uncertain significance. Following WES, the siblings underwent hCG stimulation testing with measurement of testosterone, androstenedione, and dihydrotestosterone which was non-diagnostic. To confirm pathogenicity of the HSD17B3 variants, we performed transient transfection of HEK-293 cells and measured conversion of radiolabeled androstenedione to testosterone. Both HSD17B3 variants decreased conversion of radiolabeled androstenedione to testosterone. As pathogenic HSD17B3 variants are rare causes of 46, XY DSD and hCG stimulation testing may not be diagnostic for 17β-HSD3 deficiency, WES in 46, XY individuals with DSDs can increase diagnostic yield and identify genomic variants for functional characterization of disruption of testosterone production.
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Affiliation(s)
- Sofia E Luna
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO, USA
| | - Daniel J Wegner
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO, USA
| | - Sarah Gale
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ping Yang
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO, USA
| | - Abby Hollander
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO, USA
| | - Lori St Dennis-Feezle
- Department of Pediatrics, Indiana University School of Medicine and Riley Children's Hospital, Indianapolis, IN, USA
| | - Zeina M Nabhan
- Department of Pediatrics, Indiana University School of Medicine and Riley Children's Hospital, Indianapolis, IN, USA
| | - Daniel S Ory
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - F Sessions Cole
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO, USA
| | - Jennifer A Wambach
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO, USA.
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16
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Unal E, Karakaya AA, Beştaş A, Yıldırım R, Taş FF, Onay H, Özkınay F, Haspolat YK. Identification of four novel variant in the AMHR2 gene in six unrelated Turkish families. J Endocrinol Invest 2021; 44:1301-1307. [PMID: 33025551 DOI: 10.1007/s40618-020-01437-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 07/13/2020] [Accepted: 09/26/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Persistent Müllerian duct syndrome (PMDS) is characterized by the persistence of Müllerian structures in male with normal phenotype. Most cases occur as a result of mutations in the anti-Müllerian hormone (AMH) or AMHR2 genes. In this study, we aim to discuss the results of clinical, laboratory, and molecular genetic analysis of cases detected to have AMHR2 gene mutation. METHODS A total of 11 cases from 6 families were included in the study. AMHR2 gene mutation analyses were performed by sequencing of the coding exons and the exon-intron boundaries of the genes. The American College of Medical Genetics guidelines were used for the classification of the detected variants. RESULTS Six of the 11 cases were admitted due to bilateral undescended testes and five cases due to inguinal hernia (three transverse testicular ectopia and two hernia uterus inguinalis). All cases had normal AMH levels. Seven different variants were identified in the six families. The variants detected in four cases were considered novel (c.78del, c.71G > A, c.1460dup, c.1319A > G). Two of the novel variants were missense (exon 2 and exon 10) mutations, one was deletion (exon 2), and one duplication (exon 11). CONCLUSION We identified four novel mutations in the AMHR2 gene resulting in PMDS. Duplication mutation (c.1460dup) in the AMHR2 gene causing PMDS was demonstrated for the first time. The most important complications of PMDS are infertility and malignancy. Early diagnosis is vital to preventing malignancy. Vas deferens and vascular structures may be injured during orchiopexy. Therefore, patients should always be referred to experienced clinics.
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MESH Headings
- Anti-Mullerian Hormone/blood
- Child, Preschool
- Consanguinity
- Disorder of Sex Development, 46,XY/diagnosis
- Disorder of Sex Development, 46,XY/genetics
- Disorder of Sex Development, 46,XY/physiopathology
- Early Diagnosis
- Humans
- Infertility, Male/diagnosis
- Infertility, Male/etiology
- Male
- Mutation
- Neoplasms/diagnosis
- Neoplasms/etiology
- Neoplasms/prevention & control
- Pedigree
- Receptors, Peptide/genetics
- Receptors, Transforming Growth Factor beta/genetics
- Turkey
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Affiliation(s)
- E Unal
- Department of Pediatric Endocrinology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey.
| | - A A Karakaya
- Department of Pediatric Endocrinology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - A Beştaş
- Department of Pediatric Endocrinology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - R Yıldırım
- Department of Pediatric Endocrinology, Diyarbakır Children's Hospital, Diyarbakir, Turkey
| | - F F Taş
- Department of Pediatric Endocrinology, Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey
| | - H Onay
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - F Özkınay
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Y K Haspolat
- Department of Pediatric Endocrinology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
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17
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Hassan HA, Essawi ML, Mekkawy MK, Mazen I. Novel mutations of the LHCGR gene in two families with 46,XY DSD causing Leydig cell hypoplasia I. Hormones (Athens) 2020; 19:573-579. [PMID: 32666356 DOI: 10.1007/s42000-020-00226-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 02/06/2020] [Accepted: 06/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Leydig cell hypoplasia is a rare autosomal recessive 46,XY disorder of sexual development (DSD). It is caused by homozygous or compound heterozygous inactivating mutations in the human luteinizing hormone/chorionic gonadotropin hormone receptor (LHCGR) gene. In Leydig cell hypoplasia type I, patients are characterized by predominantly female external genitalia, which usually go unrecognized until the age of puberty. METHODS This study reports three patients descending from two unrelated families. We performed clinical, hormonal, histopathological, molecular, and bioinformatics studies for the studied cases. RESULTS All investigations suggested 46,XY DSD and Leydig cell hypoplasia. Molecular analysis showed two novel homozygous inactivating mutations (p.Glu148Ter and p.Leu104Pro) within the extracellular domain of the LHCGR gene. CONCLUSION Although the mutations of the LHCGR gene are distributed heterogeneously, without hotspot or recurrent mutations, about one fifth of the reported mutations worldwide have been detected in Arab patients. This is probably due to the high consanguinity rate in these populations, which increases the percentage of autosomal recessive disorders and the homozygous LHCGR gene mutations.
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Affiliation(s)
- Heba Amin Hassan
- Medical Molecular Genetics Department, Division of Human Genetics and Genome Research, National Research Centre, 33 El Buhouth St., Dokki, Cairo, 12311, Egypt.
| | - M L Essawi
- Medical Molecular Genetics Department, Division of Human Genetics and Genome Research, National Research Centre, 33 El Buhouth St., Dokki, Cairo, 12311, Egypt
| | - M K Mekkawy
- Human Cytogenetics Department, Division of Human Genetics and Genome Research, National Research Centre, Cairo, Egypt
| | - I Mazen
- Clinical Genetics Department, Division of Human Genetics and Genome Research, National Research Centre, Cairo, Egypt
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18
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Ishii T, Tajima T, Kashimada K, Mukai T, Tanahashi Y, Katsumata N, Kanno J, Hamajima T, Miyako K, Ida S, Hasegawa T. Clinical Features of 57 Patients with Lipoid Congenital Adrenal Hyperplasia: Criteria for Nonclassic Form Revisited. J Clin Endocrinol Metab 2020; 105:5896589. [PMID: 32835366 DOI: 10.1210/clinem/dgaa557] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Received: 05/30/2020] [Accepted: 08/14/2020] [Indexed: 02/13/2023]
Abstract
CONTEXT Lipoid congenital adrenal hyperplasia (LCAH) is caused by mutations in STAR. Classic (CLCAH) and nonclassic (NCLCAH) forms were reported as total and partial deficiencies, respectively, of adrenal and gonadal steroid hormones. The rarity of LCAH has precluded large-scale epidemiological and clinical investigations. OBJECTIVE To determine the epidemiological and clinical characteristics of 2 forms of LCAH. DESIGN A multicenter cross-sectional cohort study in Japan on December 1, 2017. PARTICIPANTS Fifty-seven patients with LCAH (median age, 23.7 years; range, 0.0-47.5 years). MAIN OUTCOME MEASURES Patient demographics, STAR genotype, Quigley grade, endocrinological and imaging data, treatment, and prognosis. RESULTS Fifty-three and 4 patients fulfilled definite and probable diagnostic criteria for LCAH, respectively. When NCLCAH was defined as either Quigley grade 1 in XY karyotype, no episode of salt losing or requirement of fludrocortisone, or onset of primary adrenal insufficiency (PAI) at 1 year or older, patients were divided into groups of 43 patients with CLCAH (75.4%), 11 with NCLCAH (19.3%), and 3 with unclassified LCAH (5.3%). All of the patients with CLCAH and 7/11 NCLCAH (63.6%) were treated with fludrocortisone. CLCAH was diagnosed at a significantly younger age than NCLCAH (median, 0.0 vs 4.0 years). STAR-Arg272Cys or -Met225Thr was identified only in NCLCAH (8/11, 72.7%). CONCLUSIONS We demonstrated the relative proportions and clinical and molecular characteristics of NCLCAH and CLCAH in Japan. These criteria for NCLCAH correspond to all previously published cases and our cases whose masculinization of the external genitalia, ability of mineralocorticoid production, and onset of PAI were described.
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MESH Headings
- Adolescent
- Adrenal Hyperplasia, Congenital/diagnosis
- Adrenal Hyperplasia, Congenital/drug therapy
- Adrenal Hyperplasia, Congenital/genetics
- Adult
- Child
- Child, Preschool
- Cross-Sectional Studies
- Disorder of Sex Development, 46,XY/diagnosis
- Disorder of Sex Development, 46,XY/drug therapy
- Disorder of Sex Development, 46,XY/genetics
- Female
- Fludrocortisone/therapeutic use
- Humans
- Infant
- Infant, Newborn
- Japan
- Middle Aged
- Mineralocorticoids/therapeutic use
- Mutation
- Phenotype
- Phosphoproteins/genetics
- Prognosis
- Young Adult
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Affiliation(s)
- Tomohiro Ishii
- Research Committee on Disorders of Adrenal Hormones, Research on Intractable Diseases, Health and Labour Sciences Research Grants, Tokyo, Japan
- Disorders of Sex Development and Adrenal Disorders Committee, the Japanese Society for Pediatric Endocrinology, Fushimi-ku, Kyoto, Japan
- Department of Pediatrics, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Toshihiro Tajima
- Research Committee on Disorders of Adrenal Hormones, Research on Intractable Diseases, Health and Labour Sciences Research Grants, Tokyo, Japan
- Department of Pediatrics, Jichi Medical University Tochigi Children's Medical Center, Shimotsuke, Tochigi, Japan
| | - Kenichi Kashimada
- Research Committee on Disorders of Adrenal Hormones, Research on Intractable Diseases, Health and Labour Sciences Research Grants, Tokyo, Japan
- Disorders of Sex Development and Adrenal Disorders Committee, the Japanese Society for Pediatric Endocrinology, Fushimi-ku, Kyoto, Japan
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tokuo Mukai
- Research Committee on Disorders of Adrenal Hormones, Research on Intractable Diseases, Health and Labour Sciences Research Grants, Tokyo, Japan
- Disorders of Sex Development and Adrenal Disorders Committee, the Japanese Society for Pediatric Endocrinology, Fushimi-ku, Kyoto, Japan
- Department of Pediatrics, Asahikawa-Kosei General Hospital, Asahikawa, Hokkaido, Japan
| | - Yusuke Tanahashi
- Research Committee on Disorders of Adrenal Hormones, Research on Intractable Diseases, Health and Labour Sciences Research Grants, Tokyo, Japan
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Noriyuki Katsumata
- Research Committee on Disorders of Adrenal Hormones, Research on Intractable Diseases, Health and Labour Sciences Research Grants, Tokyo, Japan
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Junko Kanno
- Disorders of Sex Development and Adrenal Disorders Committee, the Japanese Society for Pediatric Endocrinology, Fushimi-ku, Kyoto, Japan
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Takashi Hamajima
- Disorders of Sex Development and Adrenal Disorders Committee, the Japanese Society for Pediatric Endocrinology, Fushimi-ku, Kyoto, Japan
- Department of Endocrinology and Metabolism, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Kenichi Miyako
- Disorders of Sex Development and Adrenal Disorders Committee, the Japanese Society for Pediatric Endocrinology, Fushimi-ku, Kyoto, Japan
- Department of Endocrinology and Metabolism, Fukuoka Children's Hospital, Fukuoka, Fukuoka, Japan
| | - Shinobu Ida
- Disorders of Sex Development and Adrenal Disorders Committee, the Japanese Society for Pediatric Endocrinology, Fushimi-ku, Kyoto, Japan
- Department of Pediatric Gastroenterology and Endocrinology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Tomonobu Hasegawa
- Research Committee on Disorders of Adrenal Hormones, Research on Intractable Diseases, Health and Labour Sciences Research Grants, Tokyo, Japan
- Department of Pediatrics, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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19
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Unal E, Yıldırım R, Taş FF, Tekin S, Ceylaner S, Haspolat YK. A rare cause of delayed puberty in two cases with 46,XX and 46,XY karyotype: 17 α-hydroxylase deficiency due to a novel variant in CYP17A1 gene. Gynecol Endocrinol 2020; 36:739-742. [PMID: 31885295 DOI: 10.1080/09513590.2019.1707798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/25/2022] Open
Abstract
Aims: 17α-hydroxylase deficiency is a rare form of congenital adrenal hyperplasia (CAH) which is inherited autosomal recessive. It occurs result of a mutations in gene cytochrome (CYP)17A1, which encodes both 17α-hydroxylase and 17,20-lyase enzymes. The main clinical findings of the disease are delayed puberty, primary amenorrhea in females, and disorders of sex development (DSD) in males. Also, hypertension and hypokalemia can be seen in both sexes. In this paper, we describe the clinical and genetic changes of two patients with 46,XY and 46,XX karyotypes from two different families who were diagnosed with complete 17α-hydroxylase enzyme deficiency.Methods: In this study various methods including clinical, hormonal, radiological and genetic analyzes were used. Blood samples were obtained for genetic tests. Genomic DNA was extracted from peripheral blood leukocytes, and coding sequence abnormalities of the CYP17 gene were assessed by polymerase chain reaction and direct sequencing analysis.Results: 17α-hydroxylase deficiency was diagnosed in 2 patients with 46,XX and 46,XY karyotype who presented with hypertension and delayed puberty. The pQ80 * (c.238C > T) mutation detected in both cases was evaluated as a novel variant.
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MESH Headings
- 46, XX Disorders of Sex Development/diagnosis
- 46, XX Disorders of Sex Development/genetics
- Adolescent
- Adrenal Hyperplasia, Congenital/diagnosis
- Adrenal Hyperplasia, Congenital/genetics
- Disorder of Sex Development, 46,XY/diagnosis
- Disorder of Sex Development, 46,XY/genetics
- Female
- Humans
- Karyotype
- Mutation, Missense
- Polymorphism, Single Nucleotide
- Puberty, Delayed/diagnosis
- Puberty, Delayed/genetics
- Steroid 17-alpha-Hydroxylase/genetics
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Affiliation(s)
- Edip Unal
- Department of Pediatric Endocrinology, Dicle University Medical Faculty, Diyarbakir, Turkey
| | - Ruken Yıldırım
- Department of Pediatric Endocrinology, Diyarbakır Children's Hospital, Diyarbakir, Turkey
| | - Funda Feryal Taş
- Department of Pediatric Endocrinology, Dicle University Medical Faculty, Diyarbakir, Turkey
| | - Suat Tekin
- Department of Pediatrics, Dicle University Medical Faculty, Diyarbakir, Turkey
| | - Serdar Ceylaner
- Intergen Genetic Diagnosis Center, Department of Medical Genetics, Ankara, Turkey
| | - Yusuf Kenan Haspolat
- Department of Pediatric Endocrinology, Dicle University Medical Faculty, Diyarbakir, Turkey
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Kruszewska J, Krzywdzińska S, Grymowicz M, Smolarczyk R, Meczekalski B. POI after chemotherapy and bone marrow transplant may mimic disorders of sexual differentiation - a case report of a patient with primary amenorrhea and 46, XY karyotype. Gynecol Endocrinol 2020; 36:564-566. [PMID: 31858843 DOI: 10.1080/09513590.2019.1703941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/12/2022] Open
Abstract
Cytogenetic examination may be useful in determining the reason for primary amenorrhea in phenotypically female patients. The result 46, XY usually indicates two syndromes: complete androgen insensitivity or pure gonadal dysgenesis. We report a case of a patient, who due to acute lymphoblastic leukemia in childhood was treated with total body irradiation and bone marrow transplantation. Later on the patient presented with symptoms typical for premature ovarian failure and male karyotype in peripheral lymphocytes. The cytogenetic examination for peripheral cells showed normal female karyotype. Therefore, it has been concluded that ovarian function impairment resulted rather from the gonadotoxic effect of oncological treatment than as a disorder of sexual differentiation. The survival rates of childhood cancer are very high and some of the patients will experience premature ovarian failure. It must be remembered that after bone marrow transplantation karyotype of peripheral lymphocytes may be misleading.
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Affiliation(s)
- Jagoda Kruszewska
- Department of Gynaecological Endocrinology, Students Scientific Society, Medical Unversity of Warsaw, Warsaw, Poland
| | - Sandra Krzywdzińska
- Department of Gynaecological Endocrinology, Students Scientific Society, Medical Unversity of Warsaw, Warsaw, Poland
| | - Monika Grymowicz
- Department of Gynaecological Endocrinology, Students Scientific Society, Medical Unversity of Warsaw, Warsaw, Poland
| | - Roman Smolarczyk
- Department of Gynaecological Endocrinology, Students Scientific Society, Medical Unversity of Warsaw, Warsaw, Poland
| | - Blazej Meczekalski
- Department of Gynaecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
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Jacobson JD, Willig LK, Gatti J, Strickland J, Egan A, Saunders C, Farrow E, Heckert LL. High Molecular Diagnosis Rate in Undermasculinized Males with Differences in Sex Development Using a Stepwise Approach. Endocrinology 2020; 161:5721303. [PMID: 32010941 DOI: 10.1210/endocr/bqz015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Received: 07/23/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022]
Abstract
Differences of sex development (DSDs) are a constellation of conditions that result in genital ambiguity or complete sex reversal. Although determining the underlying genetic variants can affect clinical management, fewer than half of undermasculinized males ever receive molecular diagnoses. Next-generation sequencing (NGS) technology has improved diagnostic capabilities in several other diseases, and a few small studies suggest that it may improve molecular diagnostic capabilities in DSDs. However, the overall diagnostic rate that can be achieved with NGS for larger groups of patients with DSDs remains unknown. In this study, we aimed to implement a tiered approach to genetic testing in undermasculinized males seen in an interdisciplinary DSD clinic to increase the molecular diagnosis rate in this group. We determined the diagnosis rate in patients undergoing all clinically available testing. Patients underwent a stepwise approach to testing beginning with a karyotype and progressing through individual gene testing, microarray, panel testing, and then to whole-exome sequencing (WES) if no molecular cause was found. Deletion/duplication studies were also done if deletions were suspected. Sixty undermasculinized male participants were seen in an interdisciplinary DSD clinic from 2008 to 2016. Overall, 37/60 (62%) of patients with Y chromosomes and 46% of those who were 46XY received molecular diagnoses. Of the 46,XY patients who underwent all available genetic testing, 18/28 (64%) achieved molecular diagnoses. This study suggests that the addition of WES testing can result in a higher rate of molecular diagnoses compared to genetic panel testing.
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Affiliation(s)
- Jill D Jacobson
- Division of Endocrinology and Diabetes, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Laurel K Willig
- Division of Nephrology, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
- Center for Pediatric Genomic Medicine Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - John Gatti
- Division of Urology, Department of Surgery, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Julie Strickland
- Division of Pediatric and Adolescent Gynecology, Department of Surgery, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Anna Egan
- Developmental and Behavioral Sciences, Department of Pediatrics, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Carol Saunders
- Center for Pediatric Genomic Medicine Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Emily Farrow
- Center for Pediatric Genomic Medicine Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Leslie L Heckert
- Department of Molecular and Integrative Physiology, University of Kansas School of Medicine, Kansas City, Kansas
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Wang K, Zhao X, Tu H, Lin H. A Case of Complex Chromosome Translocation: 46, XY, t(4; 10; 13) (q31; q23; q12). Clin Lab 2020; 65. [PMID: 31710435 DOI: 10.7754/clin.lab.2019.190434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Complex chromosome rearrangement (CCR) often results in patients with mental retardation, stunted growth, and multiple abnormalities. CCR carriers are at high risk of adverse pregnancy, and prenatal diagnosis should be made even in normal pregnancy. The incidence of spermatogenesis disorder is high in male CCR carriers, and the chromosome involved with CCR has an impact on the fertility of male carriers. METHODS We report a case of complex chromosome translocation: 46, XY, t(4; 10; 13) (q31; q23; q12). The lymphocytes in peripheral blood were cultured to examine the patient's karyotype. RESULTS The patient's karyotype was detected and identified as 46, XY, t(4;10;13) (4pter→4q31::13q12→13qter; 10pter→10q23::4q31→4qter; 13pter→13q12::10q23→10qter). Complex chromosome translocations occurred on chromosomes 4, 10, and 13. When combined with normal gamete, one or two derived chromosomes may be obtained in the offspring, resulting in the increase or decrease of the translocation segments of a chromosome (part of trisomy or part of monomers), thus resulting in fetal abortion, stillbirth or deformed children, etc. Conclusions: Fertility and pregnancy outcome cannot be completely determined according to the complexity of karyotype. For patients with such chromosomal abnormalities, prenatal diagnosis should be strictly carried out to prevent the birth of children with chromosomal diseases if they want to have healthy children.
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MESH Headings
- Abortion, Spontaneous/genetics
- Abortion, Spontaneous/physiopathology
- Adult
- Chromosomes, Human, Pair 10
- Chromosomes, Human, Pair 13
- Chromosomes, Human, Pair 4
- Disorder of Sex Development, 46,XY/diagnosis
- Disorder of Sex Development, 46,XY/genetics
- Disorder of Sex Development, 46,XY/physiopathology
- Female
- Fertility/genetics
- Genetic Predisposition to Disease
- Humans
- Infertility, Male/diagnosis
- Infertility, Male/genetics
- Infertility, Male/physiopathology
- Karyotype
- Male
- Phenotype
- Pregnancy
- Translocation, Genetic
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Tanabe K, Mori S, Kita Y, Wada M, Kenji B, Itaru O, Takaaki A, Satoshi I, Kosei M, Natsugoe S. A rare case report of bilateral recurrent inguinal hernia due to persistent Müllerian duct syndrome treated by transabdominal preperitoneal repair. Medicine (Baltimore) 2020; 99:e19079. [PMID: 32049810 PMCID: PMC7035117 DOI: 10.1097/md.0000000000019079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Persistent Müllerian duct syndrome (PMDS) is a rare disease occurring in men with an otherwise completely normal phenotype, in which female internal sex organs are present, including a uterus, fallopian tubes, cervix, and vagina. We report a case of bilateral recurrent inguinal hernia due to PMDS treated by transabdominal preperitoneal repair (TAPP). PATIENT CONCERNS A 72-year-old male presented with a complaint of swelling on both sides of the groin. The patient had undergone bilateral inguinal hernia suture repair 50 years ago. DIAGNOSIS Bilateral recurrent inguinal hernia INTERVENTIONS:: TAPP was performed. There was a fibrous structure linking the left and right hernia orifice and a muscular structure in the hernia sac on the left. We noticed that the muscular structure was a vagina and fibrous structure was the salpinx, and we diagnosed the patient with PMDS. Supravaginal hysterectomy and right salpingectomy were performed. After that a preperitoneal mesh repair was performed for bilateral inguinal hernia. OUTCOMES Histologically, the diagnosis was confirmed as PMDS. The patient had an uneventful recovery. CONCLUSION This case is the first case of bilateral recurrent inguinal hernia due to PMDS managed by TAPP.
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Affiliation(s)
- Kan Tanabe
- Department of Digestive Surgery, Breast and Thyroid Surgery Graduate School of Metical Sciences Kagoshima University, Kagoshima, Japan
| | - Shinichiro Mori
- Department of Digestive Surgery, Breast and Thyroid Surgery Graduate School of Metical Sciences Kagoshima University, Kagoshima, Japan
| | - Yoshiaki Kita
- Department of Digestive Surgery, Breast and Thyroid Surgery Graduate School of Metical Sciences Kagoshima University, Kagoshima, Japan
| | - Masumi Wada
- Department of Digestive Surgery, Breast and Thyroid Surgery Graduate School of Metical Sciences Kagoshima University, Kagoshima, Japan
| | - Baba Kenji
- Department of Digestive Surgery, Imamura General Hospital
| | - Omoto Itaru
- Department of Digestive Surgery, Breast and Thyroid Surgery Graduate School of Metical Sciences Kagoshima University, Kagoshima, Japan
| | - Arigami Takaaki
- Department of Digestive Surgery, Breast and Thyroid Surgery Graduate School of Metical Sciences Kagoshima University, Kagoshima, Japan
| | - Iino Satoshi
- Department of Digestive Surgery, Breast and Thyroid Surgery Graduate School of Metical Sciences Kagoshima University, Kagoshima, Japan
| | - Maemura Kosei
- Department of Digestive Surgery, Breast and Thyroid Surgery Graduate School of Metical Sciences Kagoshima University, Kagoshima, Japan
| | - Shoji Natsugoe
- Department of Digestive Surgery, Breast and Thyroid Surgery Graduate School of Metical Sciences Kagoshima University, Kagoshima, Japan
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Hána V, Ježková J, Kosák M, Kršek M, Hána V, Hill M. Serum steroid profiling in Cushing's syndrome patients. J Steroid Biochem Mol Biol 2019; 192:105410. [PMID: 31201926 DOI: 10.1016/j.jsbmb.2019.105410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Received: 11/30/2018] [Revised: 05/11/2019] [Accepted: 06/12/2019] [Indexed: 12/24/2022]
Abstract
CONTEXT Cushing's syndrome is caused by increased exposure to cortisol. Discrimination of different causes of endogenous hypercortisolism can make a diagnostic dilemma. PATIENTS AND METHODS In serum samples from patients with Cushing's syndrome (47 with Cushing's disease, 6 with ectopic ACTH-dependent Cushing's syndrome, 16 with adrenal adenoma, 7 bilateral adrenal hyperplasia (BMAH) with overt Cushing's syndrome, 42 controls from the general population) using novel method based on gas chromatography-tandem mass spectrometry (GC-MS/MS) we measured 94 serum steroids to search for steroid fingerprint of each subtype. RESULTS Patients with Cushing's disease and ectopic ACTH producing tumors showed elevated levels of androgens and their metabolites when compared with healthy controls. Mineralocorticoid precursors were also elevated in ectopic ACTH syndrome. The levels of androgens were decreased in adrenal adenomas and BMAH. ROC analysis showed 100% sensitivity and 93.6% specificity for 11β-hydroxyepiandrosterone sulfate for discrimination of Cushing's disease from ectopic ACTH secretion. We didn't find any significant (p < 0.05) difference in steroids that would discriminate BMAH from unilateral adenomas causing Cushing's syndrome. CONCLUSION Various causes of Cushing's syndrome show particular steroid fingerprints that can be used to discriminate and may help to achieve appropriate clinical diagnosis.
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Affiliation(s)
- Václav Hána
- 3rd Department of Internal Medicine, General University Hospital, 1st Faculty of Medicine, Charles University, U Nemocnice 1, Prague 2, 128 08, Czech Republic.
| | - Jana Ježková
- 3rd Department of Internal Medicine, General University Hospital, 1st Faculty of Medicine, Charles University, U Nemocnice 1, Prague 2, 128 08, Czech Republic
| | - Mikuláš Kosák
- 3rd Department of Internal Medicine, General University Hospital, 1st Faculty of Medicine, Charles University, U Nemocnice 1, Prague 2, 128 08, Czech Republic
| | - Michal Kršek
- 3rd Department of Internal Medicine, General University Hospital, 1st Faculty of Medicine, Charles University, U Nemocnice 1, Prague 2, 128 08, Czech Republic
| | - Václav Hána
- 3rd Department of Internal Medicine, General University Hospital, 1st Faculty of Medicine, Charles University, U Nemocnice 1, Prague 2, 128 08, Czech Republic
| | - Martin Hill
- Steroid Hormone Unit, Institute of Endocrinology, Národní 8/139, 113 94, Prague 1, Czech Republic
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25
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Sheikh WH, Asif N, Haroon ZH, Ejaz A, Ain QU, Shehzad N. Diagnostic accuracy of human chorionic gonadotropins (HCG) stimulation test in XY-disorders of sex development (XY-DSD) presented in Armed Forces Institute of Pathology. J PAK MED ASSOC 2019; 69:1090-1093. [PMID: 31431758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To determine diagnostic accuracy of human chorionic gonadotropins stimulation test in differentiating androgen insensitivity syndrome and 5-alpha reductase deficiency, keeping testosterone to dihydrotestosterone ratio as the gold standard. METHODS The cross-sectional study was conducted at the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from January to December, 2016, and comprised patients aged 01 day to 20 years having XY chromosomes on karyotyping and with a spectrum of phenotypes. Blood samples were collected from each subject for basal serum testosterone, serum luteinizing hormone and serum follicular stimulating hormone level. Human chorionic gonadotropins stimulation test was performed in every subject as per the protocol. Sandwich chemiluminescence immunoassay technique was used to analyse serum samples. Serum dihydrotestosterone level was also detected to determine testosterone and dihydrotestosterone ratio. Data was analysed using SPSS 24. . RESULTS Of the 104 subjects with a mean age of 1.78}0.95 years,96(92.3%) were diagnosed as cases of androgen insensitivity syndrome on the basis of human chorionic gonadotropins stimulation response level, which was 2-9 times of basal serum testosterone level. Also, 8(7.7%) subjects were diagnosed to have 5-alpha reductase deficiency syndrome. In such subjects, post-human chorionic gonadotropins response level of serum testosterone was more than 10 times of the basal level. CONCLUSIONS The human chorionic gonadotropins stimulation test was found to be comparable to testosterone-to dihydrotestosterone ratio in differentiating between case of androgen insensitivity syndrome and 5-alpha reductase deficiency.
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Affiliation(s)
| | - Naveed Asif
- Armed Forced Institute of Pathology, Rawalpindi
| | | | - Aamir Ejaz
- Rehman Institute of Medical Sciences, Peshawar
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26
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Islam R, Lane S, Williams SA, Becker CM, Conway GS, Creighton SM. Establishing reproductive potential and advances in fertility preservation techniques for XY individuals with differences in sex development. Clin Endocrinol (Oxf) 2019; 91:237-244. [PMID: 31004515 DOI: 10.1111/cen.13994] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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] [Received: 11/08/2018] [Revised: 03/07/2019] [Accepted: 04/15/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Discordance between gonadal type and gender identity has often led to an assumption of infertility in patients with differences in sex development (DSD). However, there is now greater recognition of fertility being an important issue for this group of patients. Currently, gonadal tissue that may have fertility potential is not being stored for individuals with DSD and, where gonadectomy forms part of management, is often discarded. The area of fertility preservation has been predominantly driven by oncofertility which is a field dedicated to preserving the fertility of patients undergoing gonadotoxic cancer treatment. The use of fertility preservation techniques could be expanded to include individuals with DSD where functioning gonads are present. METHODS This is a systematic literature review evaluating original research articles and relevant reviews between 1974 and 2018 addressing DSD and fertility, in vitro maturation of sperm, and histological/ultrastructural assessment of gonadal tissue in complete and partial androgen insensitivity syndrome, 17β-hydroxysteroid dehydrogenase type 3 and 5α-reductase deficiency. CONCLUSION Successful clinical outcomes of ovarian tissue cryopreservation are paving the way for similar research being conducted using testicular tissue and sperm. There have been promising results from both animal and human studies leading to cryopreservation of testicular tissue now being offered to boys prior to cancer treatment. Although data are limited, there is evidence to suggest the presence of reproductive potential in the gonads of some individuals with DSD. Larger, more detailed studies are required, but if these continue to be encouraging, individuals with DSD should be given the same information, opportunities and access to fertility preservation as other patient groups.
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Affiliation(s)
- Rumana Islam
- Department of Reproductive Medicine, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Sheila Lane
- Department of Paediatric Oncology and Haematology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Suzannah A Williams
- Nuffield Department of Women's and Reproductive Health, Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Christian M Becker
- Nuffield Department of Women's and Reproductive Health, Oxford Endometriosis CaRe Centre, Women's Centre, John Radcliffe Hospital University of Oxford, Oxford, UK
| | - Gerard S Conway
- Department of Endocrinology, University College London Hospitals, London, UK
| | - Sarah M Creighton
- Elizabeth Garrett Anderson UCL Institute of Women's Health, University College London Hospitals, London, UK
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Jabeen S, Faisal M, Nisar M. Disorders Of Sex Differentiation: Evaluation And Management, A Dilemma. J Ayub Med Coll Abbottabad 2019; 31:454-458. [PMID: 31535527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The term intersex used in the past has been replaced by "Disorders of Sex Differentiation". In this condition the development of chromosomal, gonadal or anatomical sex is atypical. This problem creates anxiety to the parents and a challenge for attending doctor. The problems faced by the individual are sexual, reproductive, sex of raring, placement in the society and psychological impact. The optimal management of the patient should be individualized by multidisciplinary team. Three cases of Disorders of Sex Differentiation (DSD) are presented with different causes and presentations. Two cases carrying XY karyotype pattern, while one case was of XX. The diagnosis of swyers syndrome, 5 alpha reductase deficiency and congenital adrenal hyperplasia was made on the basis of genital tract development, hormonal analysis and karyotyping. The strange feature which was common in all these cases was the wish of patients as well as family members to adopt sex of raring as male.
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MESH Headings
- 3-Oxo-5-alpha-Steroid 4-Dehydrogenase/deficiency
- Adolescent
- Adrenal Hyperplasia, Congenital/diagnosis
- Adrenal Hyperplasia, Congenital/therapy
- Child
- Disorder of Sex Development, 46,XY/diagnosis
- Disorder of Sex Development, 46,XY/therapy
- Female
- Gonadal Dysgenesis, 46,XY/diagnosis
- Gonadal Dysgenesis, 46,XY/therapy
- Humans
- Hypospadias/diagnosis
- Hypospadias/therapy
- Male
- Steroid Metabolism, Inborn Errors/diagnosis
- Steroid Metabolism, Inborn Errors/therapy
- Young Adult
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Affiliation(s)
- Sadaqat Jabeen
- Department of Gynaecology, MTI lady Reading Hospital, Peshawar, Pakistan
| | - Mahnaz Faisal
- Department of Gynaecology, MTI lady Reading Hospital, Peshawar, Pakistan
| | - Maleeha Nisar
- Department of Gynaecology, MTI lady Reading Hospital, Peshawar, Pakistan
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28
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Ahmad A, Ayub F, Saleem I, Ahmad N. Initial assessment of a child with suspected disorder of sex development. J PAK MED ASSOC 2019; 69:711-717. [PMID: 31105293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Disorders of sex development (DSD) are defined as discrepancy between chromosomal, gonadal and anatomic sex. The basic principles for the management of DSD include a multidisciplinary approach for gender assignment. Clinical assessment includes a detailed history and examination of external genitalia. Most of the disorders with symmetrical gonades indicate hormonal cause while asymmetrical gonades are found in chromosomal DSDs. Karyotyping will indicate a 46XX DSD, 46 XY DSD or mosicism. Internal anatomy is defined by ultrasonography, genitoscopy and laparoscopy. Human chorionic gonadotrophins (hCG) stimulation test is carried out in under-virilised males to see the function of Leydig cells in testes. The Most common cause of 46XX DSD is congenital adrenal hyperplasia (CAH). The decision of gender assignment surgery is to be taken in a multidisciplinary environment and with informed consent of the parents. Most of 46 XX CAH patients, even if markedly virilised, and 46 XY complete androgen insensitivity syndrome are raised as females. Similarly, most of 5-α reductase deficiency and 17-β hydroxysteroid dehydrogenase deficiency patients are assigned to the male gender. The decision in cases of mixed gondal dysgenesis and ovotesticular DSD is based on the development of external and internal genitalia. Patients with androgen biosynthetic defects, partial androgen insensitivity syndrome are usually assigned to the male gender.
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Affiliation(s)
| | | | | | - Nisar Ahmad
- Medical Officer, Hayat Abad Medical Complex, Peshawar
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29
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Sharma UK, Thapa DK, Pokhrel D, Shah AK. Persistent Mullerian Duct Syndrome with Polysplenia and Short Pancreas: A Case Report. JNMA J Nepal Med Assoc 2019. [PMID: 31477947 PMCID: PMC8827582 DOI: 10.31729/jnma.4298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Persistent Mullerian duct syndrome is a rare entity and usually presents with common symptoms of undescended testis and hernia. The syndrome is caused by an insufficient amount of Mullerian inhibiting substance or due to the insensitivity of the target organ to Mullerian inhibiting substance. Polysplenia is a rare congenital disease manifested by multiple small accessory spleens. The association of these two entities, Persistent Mullerian duct syndrome and polysplenia, is rare and has not been reported in the literature. We reported a case of a 27 years old male presented with complains of right flank pain and nausea. Ultrasound showed right ureteric calculus with hydronephrosis and elongated soft tissue mass posterior to bladder. Contrast enhanced Computed Tomography showed soft tissue suggestive of infantile uterine structure with multiple splenculi and short pancreas. He was diagnosed as Persistent Mullerian duct syndrome with unilateral cryptorchidism, polysplenia and short pancreas, coincidentally detected while evaluating for ureteric colic. He underwent Ureteroscopic Lithotripsy with stenting for ureteric calculus, however, he refused laparotomy with excision of mullerian structures.
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Affiliation(s)
- Umesh Kumar Sharma
- Department of Radiology, B&C Medical College Teaching Hospital, Birtamod, Jhapa, Nepal
| | - Dinesh Kumar Thapa
- Department of Neurosurgery, B&C Medical College Teaching Hospital, Birtamod, Jhapa, Nepal
- Correspondence: Dr. Dinesh Kumar Thapa, Department of Neurosurgery, B&C Medical College, Teaching Hospital, Birtamod, Jhapa, Nepal. , Phone: +9779843123518
| | - Dinesh Pokhrel
- Department of Radiology, B&C Medical College Teaching Hospital, Birtamod, Jhapa, Nepal
| | - Amit Kumar Shah
- Department of Urology, B&C Medical College Teaching Hospital, Birtamod, Jhapa, Nepal
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30
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Zhao X, Su Z, Liu X, Song J, Gan Y, Wen P, Li S, Wang L, Pan L. Long-term follow-up in a Chinese child with congenital lipoid adrenal hyperplasia due to a StAR gene mutation. BMC Endocr Disord 2018; 18:78. [PMID: 30400872 PMCID: PMC6219181 DOI: 10.1186/s12902-018-0307-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/15/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Congenital lipoid adrenal hyperplasia (CLAH) is an extremely rare and the most severe form of congenital adrenal hyperplasia. Typical features include disorder of sex development, early-onset adrenal crisis and enlarged adrenal glands with fatty accumulation. CASE PRESENTATION We report a case of CLAH caused by mutations in the steroidogenic acute regulatory protein (StAR) gene. The patient had typical early-onset adrenal crisis at 2 months of age. She had normal-appearing female genitalia and a karyotype of 46, XY. The serum cortisol and adrenal steroids levels were always nearly undetectable, but the adrenocorticotropic hormone levels were extremely high. Genetic analysis revealed compound heterozygous mutations at c. 229C > T (p.Q77X) in exon 3 and c. 722C > T (p.Q258X) in exon 7 of the StAR gene. The former mutation was previously detected in only two other Chinese CLAH patients. Both mutations cause truncation of the StAR protein. The case reported here appears to be a classic example of CLAH with very small adrenal glands and is the second reported CLAH case with small adrenal glands thus far. In a 15-year follow-up, the patient's height was approximately average for females before age 4 and fell to - 1 SDS at 10 years of age. Her bone age was similar to her chronological age from age 4 to age 15 years. CONCLUSIONS In conclusion, this is a classic case of CLAH with exceptionally small adrenal glands. Q77X mutation seems to be more common in Chinese CLAH patients. Additionally, this is the first report of the growth pattern associated with CLAH after a 15-year follow-up.
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MESH Headings
- Adolescent
- Adrenal Hyperplasia, Congenital/diagnosis
- Adrenal Hyperplasia, Congenital/genetics
- Adrenal Hyperplasia, Congenital/surgery
- Amino Acid Sequence
- Asian People/genetics
- Child
- Child, Preschool
- Disorder of Sex Development, 46,XY/diagnosis
- Disorder of Sex Development, 46,XY/genetics
- Disorder of Sex Development, 46,XY/surgery
- Female
- Follow-Up Studies
- Humans
- Infant
- Mutation/genetics
- Phosphoproteins/genetics
- Time Factors
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Affiliation(s)
- Xiu Zhao
- Department of Endocrinology, Shenzhen Children’s Hospital, 7019# Yitian Road, Futian District, Shenzhen, 518038 Guangdong Province China
| | - Zhe Su
- Department of Endocrinology, Shenzhen Children’s Hospital, 7019# Yitian Road, Futian District, Shenzhen, 518038 Guangdong Province China
| | - Xia Liu
- Department of Endocrinology, Shenzhen Children’s Hospital, 7019# Yitian Road, Futian District, Shenzhen, 518038 Guangdong Province China
| | - Jianming Song
- Pathology Department, Shenzhen Children’s Hospital, Shenzhen, 518038 China
| | - Yungen Gan
- Radiology Department, Shenzhen Children’s Hospital, Shenzhen, 518038 China
| | - Pengqiang Wen
- Pediatrics Research Institute, Shenzhen Children’s Hospital, Shenzhen, 518038 China
| | - Shoulin Li
- Department of Urology, Shenzhen Children’s Hospital, Shenzhen, 518038 China
| | - Li Wang
- Department of Endocrinology, Shenzhen Children’s Hospital, 7019# Yitian Road, Futian District, Shenzhen, 518038 Guangdong Province China
| | - Lili Pan
- Department of Endocrinology, Shenzhen Children’s Hospital, 7019# Yitian Road, Futian District, Shenzhen, 518038 Guangdong Province China
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Lavergne O, Troisfontaines E, Verstraete A, Demarche M, Nicolas H. [A rare cause of cryptorchidism, the persistence of müllerian ducts syndrome]. Rev Med Liege 2018; 73:376-379. [PMID: 30113777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Persistent Müllerian Ducts Syndrome (PMDS) is a rare congenital syndrome. It is one of abnormalities of genito-sexual development that is found on the normally virilized boy (46XY). It is characterized by the development of both Wolf structures and Müller duct. The pathophysiology can be explained by an action deficit of the anti-müllerian hormone (AMH). Its clinical presentations vary depending on the localization of the testis and the associated symptoms. Its discovery is mostly fortuitous and generally made in per-operative surgery of cryptorchidism or inguinal hernia. Treatment should be surgical. It relies on two aspects : ensuring the testicular descent and performing the excision of the müllerian duct. The follow-up is identical to the cryptorchid testes and the fertility problems will be influenced by the surgical procedure as well as the timing of the treatment.
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Affiliation(s)
- O Lavergne
- Service d'Urologie, CHR Citadelle, Liège, Belgique
| | | | - A Verstraete
- Service d'Urologie, CHR Citadelle, Liège, Belgique
| | - M Demarche
- Service de Chirurgie générale, CHR Citadelle, Liège, Belgique
| | - H Nicolas
- Service d'Urologie, CHR Citadelle, Liège, Belgique
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Jia W, Zheng D, Zhang L, Li C, Zhang X, Wang F, Guan Q, Fang L, Zhao J, Xu C. Clinical and molecular characterization of 5α-reductase type 2 deficiency due to mutations (p.Q6X, p.R246Q) in SRD5A2 gene. Endocr J 2018; 65:645-655. [PMID: 29643321 DOI: 10.1507/endocrj.ej17-0542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/23/2022] Open
Abstract
Early diagnosis and optimal management for steroid 5α-reductase type 2 deficiency (5α-RD2) patients are major challenges for clinicians and mutation analysis for the 5α-reductase type 2 (SRD5A2) gene is the golden standard for the diagnosis of the disease. In silico analysis of this enzyme has not been reported due to the lack of appropriate model. Moreover, the histological and pathological changes of the gonads are largely unknown. In the present study, a 5α-RD2 patient born with abnormal external genitalia was studied and mutation analysis for SRD5A2 gene was conducted. Moreover, we constructed the homology modeling of 5α-reductase using SWISS-MODEL, followed by the molecular docking study. Furthermore, immunohistochemical staining of Ki67 for the testes tissue was conducted to investigate the potential pathological characteristics. The patient had male (46, XY) chromosomes but presented female characteristics, and the mutation analysis identified a heterozygotes mutation (p.Q6X, p.R246Q) in SRD5A2 gene. In silico analysis elucidated the potential effect of the mutation on enzyme activity. Immunohistochemical staining for the excised testes showed that 30%-50% of the germ cells were Ki67 positive, which indicated the early neoplastic potential. In conclusion, we analyzed the genotype-phenotype correlations of 5α-RD2 caused by a heterozygotes mutation (p.Q6X, p.R246Q). Importantly, we conducted the homology modeling and molecular docking for the first time, which provided a homology model for further investigations. Immunohistochemical results suggested gonadectomy or testis descent should be performed early for 5α-RD2 patient, as delayed treatment would have maintained the testes in a tumorigenic condition.
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Affiliation(s)
- Wenyu Jia
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China
| | - Dongmei Zheng
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China
| | - Liya Zhang
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China
| | - Changzhong Li
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China
| | - Xu Zhang
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China
| | - Fei Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China
| | - Qingbo Guan
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China
| | - Li Fang
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China
| | - Jiajun Zhao
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China
| | - Chao Xu
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, Shandong, 250021, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, Shandong, 250021, China
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Fu R, Lu L, Jiang J, Nie M, Wang X, Lu Z. A case report of pedigree of a homozygous mutation of the steroidogenic acute regulatory protein causing lipoid congenital adrenal hyperplasia. Medicine (Baltimore) 2017; 96:e6994. [PMID: 28538409 PMCID: PMC5457889 DOI: 10.1097/md.0000000000006994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Lipoid congenital adrenal hyperplasia (LCAH) is extremely rare, but is the most fatal form of congenital adrenal hyperplasia resulting from mutations in the steroidogenic acute regulatory protein (STAR) gene. LCAH arises from severe defects in the conversion of cholesterol to pregnenolone, the precursor of all steroids. PATIENT CONCERNS A case was reported that an 11-month-old Chinese girl who presented with a sex development disorder and hyponatremia. The clinical and genetic tests were carried out to confirm the diagnosis. The genogram of this case was also explored and analyzed. The girl presented with hyponatremia, decreased cortisol level, elevated adrenocorticotropic hormone level and female vulva despite a 46, XY karyotype. Enlarged adrenal glands and testicular-like tissue in the bilateral inguinal regions were detected with abdominal ultrasound. She was suspected of having LCAH, and definitive diagnosis was made after Sanger sequencing detected a homozygous frameshift variant c.707_708delins CTT (p.Lys236Thrfs*47) on exon 6 of the STAR gene. DIAGNOSES LCAH. INTERVENTIONS She was prescribed hydrocortisone 10 to 12 mg/m2 and 9a- fludrocortisone 100 mg/d. OUTCOMES Her skin hyperpigmentation and vomiting disappeared, and she had normal growth and development without adrenal crisis attacks. Her hormone and electrolyte levels remained normal, except for a persistently elevated ACTH level throughout 2 years of follow-up. At follow-up for 2 years, the patient is now 104.5 cm tall and weighs 23.3 kg at the age of 4 years old. Her plasma sodium and potassium concentration were normal. Her ACTH level is still elevated (1176 pg/mL). Her baseline sex hormone levels are testosterone <0.1 ng/dL and progesterone <0.08 ng/dL. The level of PRA (1.06 ng/mL per h) is within normal range. LESSONS This mutation was in accordance with previously reported gene mutations. The patient's parents were nonconsanguineous; her parents, paternal grandfather, and maternal grandmother were all found to be carriers of a STAR gene mutation. This 46 XY disorders of sex development case presented with adrenal insufficiency and female phenotype initially. The diagnosis was complicated depending on the clinical hormone workup. LCAH was confirmed by genetic tests and genogram of the family.
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MESH Headings
- Adrenal Hyperplasia, Congenital/diagnosis
- Adrenal Hyperplasia, Congenital/drug therapy
- Adrenal Hyperplasia, Congenital/genetics
- Diagnosis, Differential
- Disorder of Sex Development, 46,XY/diagnosis
- Disorder of Sex Development, 46,XY/drug therapy
- Disorder of Sex Development, 46,XY/genetics
- Female
- Frameshift Mutation
- Homozygote
- Humans
- Infant
- Pedigree
- Phosphoproteins/genetics
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Affiliation(s)
- Rong Fu
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Key Laboratory of Health and Family Planning Commission, Beijing, China
| | - Lin Lu
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Key Laboratory of Health and Family Planning Commission, Beijing, China
| | - Jun Jiang
- The Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
| | - Min Nie
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Key Laboratory of Health and Family Planning Commission, Beijing, China
| | - Xiaojing Wang
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Key Laboratory of Health and Family Planning Commission, Beijing, China
| | - Zhaolin Lu
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Key Laboratory of Health and Family Planning Commission, Beijing, China
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Altincik A, Karaca F, Onay H. Persistent Müllerian duct syndrome: A novel mutation in the Αnti-Müllerian Ηormone gene. Hormones (Athens) 2017; 16:205-208. [PMID: 28742509 DOI: 10.14310/horm.2002.1735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/28/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Persistent Müllerian duct syndrome (PMDS) is a relatively rare form of 46,XY disorder of sex development caused by the failure of formation, release or action of anti-Müllerian hormone (AMH) in intrauterine life. In this report we describe a case diagnosed with PMDS with a novel homozygous mutation in the AMH gene. CASE REPORT A 4-month-old male presented with bilateral cryptorchidism and normal external genitalia. The laboratory examination revealed normal gonadotropin levels for his age (FSH: 0.91 mIU/mL, LH: 1.23 mIU/mL, testosteron <0.13 ng/mL, respectively). AMH was undetectable (<0.01 ng/mL). Ultrasonography (USG) revealed absence of the left gonad and an intraabdominally located right gonad. Laparoscopy demonstrated the presence of a rudimentary uterus and fallopian tubes. Karyotyping revealed a normal 46,XY karyotype. Molecular genetic analysis demonstrated a novel homozygous mutation [p.C526F (c.1577G>T)] in the AMH gene. CONCLUSION PMDS should be kept in mind in all cases with bilateral crytorchidism. Orchidopexy and resection of Mulletian duct derivates, exercising extra caution with regard to maintaining vascular supply to the testis, is the recommended approach.
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Affiliation(s)
- Ayça Altincik
- Pediatric Endocrinology Clinic, Denizli State Hospital, 20100, Denizli, Turkey.
| | - Fahri Karaca
- Pediatric Surgery Clinic, Denizli State Hospital, Denizli, Turkey
| | - Hüseyin Onay
- Medical Genetics Department, Ege University Faculty of Medicine, İzmir, Turkey
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Barouti K, Markantes GK, Armeni AK, Vasileiou V, Georgopoulos NA. The male bride: a story of Sexual Female-to-Male Transformation at marriage from the Hellenistic period, recorded by Phlegon of Tralles. Hormones (Athens) 2017; 16:101-103. [PMID: 28500833 DOI: 10.14310/horm.2002.1724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/01/2017] [Indexed: 11/20/2022]
Affiliation(s)
- Konstantina Barouti
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, Rio, 26500, Greece
| | - Georgios K Markantes
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, Rio, 26500, Greece
| | - Anastasia K Armeni
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, Rio, 26500, Greece
| | - Vasiliki Vasileiou
- 1st Department of Endocrinology, Diabetes Centre, "Alexandra" Hospital, Athens, Greece
| | - Neoklis A Georgopoulos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, Rio, 26500, Greece.
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Lucas-Herald A, Bertelloni S, Juul A, Bryce J, Jiang J, Rodie M, Sinnott R, Boroujerdi M, Lindhardt Johansen M, Hiort O, Holterhus PM, Cools M, Guaragna-Filho G, Guerra-Junior G, Weintrob N, Hannema S, Drop S, Guran T, Darendeliler F, Nordenstrom A, Hughes IA, Acerini C, Tadokoro-Cuccaro R, Ahmed SF. The Long-Term Outcome of Boys With Partial Androgen Insensitivity Syndrome and a Mutation in the Androgen Receptor Gene. J Clin Endocrinol Metab 2016; 101:3959-3967. [PMID: 27403927 PMCID: PMC5095251 DOI: 10.1210/jc.2016-1372] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND In boys with suspected partial androgen insensitivity syndrome (PAIS), systematic evidence that supports the long-term prognostic value of identifying a mutation in the androgen receptor gene (AR) is lacking. OBJECTIVE To assess the clinical characteristics and long-term outcomes in young men with suspected PAIS in relation to the results of AR analysis. METHODS Through the International Disorders of Sex Development Registry, clinical information was gathered on young men suspected of having PAIS (n = 52) who presented before the age of 16 years and had genetic analysis of AR. RESULTS The median ages at presentation and at the time of the study were 1 month (range, 1 day to 16 years) and 22 years (range, 16 to 52 years), respectively. Of the cohort, 29 men (56%) had 20 different AR mutations reported. At diagnosis, the median external masculinization scores were 7 and 6 in cases with and without AR mutation, respectively (P = .9), and median current external masculinization scores were 9 and 10, respectively (P = .28). Thirty-five men (67%) required at least one surgical procedure, and those with a mutation were more likely to require multiple surgeries for hypospadias (P = .004). All cases with an AR mutation had gynecomastia, compared to 9% of those without an AR mutation. Of the six men who had a mastectomy, five (83%) had an AR mutation. CONCLUSIONS Boys with genetically confirmed PAIS are likely to have a poorer clinical outcome than those with XY DSD, with normal T synthesis, and without an identifiable AR mutation. Routine genetic analysis of AR to confirm PAIS informs long-term prognosis and management.
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MESH Headings
- Adolescent
- Adult
- Aging
- Androgen-Insensitivity Syndrome/diagnosis
- Androgen-Insensitivity Syndrome/genetics
- Androgen-Insensitivity Syndrome/physiopathology
- Child
- Child, Preschool
- Cohort Studies
- Disease Progression
- Disorder of Sex Development, 46,XY/diagnosis
- Disorder of Sex Development, 46,XY/genetics
- Disorder of Sex Development, 46,XY/physiopathology
- Gynecomastia/etiology
- Gynecomastia/surgery
- Humans
- Hypospadias/etiology
- Hypospadias/surgery
- Infant
- Infant, Newborn
- International Agencies
- Male
- Mastectomy
- Middle Aged
- Mutation
- Prognosis
- Puberty, Delayed
- Receptors, Androgen/genetics
- Receptors, Androgen/metabolism
- Registries
- Retrospective Studies
- Severity of Illness Index
- Young Adult
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Affiliation(s)
- A Lucas-Herald
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - S Bertelloni
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - A Juul
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - J Bryce
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - J Jiang
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - M Rodie
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - R Sinnott
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - M Boroujerdi
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - M Lindhardt Johansen
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - O Hiort
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - P M Holterhus
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - M Cools
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - G Guaragna-Filho
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - G Guerra-Junior
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - N Weintrob
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - S Hannema
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - S Drop
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - T Guran
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - F Darendeliler
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - A Nordenstrom
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - I A Hughes
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - C Acerini
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - R Tadokoro-Cuccaro
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - S F Ahmed
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
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Bonarriba Beltrán CR, Fernández L, Alonso D, García-Montes F. Male Pseudohermaphroditism: Ambiguous genitalia. ARCH ESP UROL 2016; 69:444-445. [PMID: 27617556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | - L Fernández
- Servicio de Urología. Hospital Universitario Son Espases. Palma de Mallorca. España
| | - D Alonso
- Servicio de Urología. Hospital Universitario Son Espases. Palma de Mallorca. España
| | - F García-Montes
- Servicio de Urología. Hospital Universitario Son Espases. Palma de Mallorca. España
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Tian HJ, Zhang JW, Wu DH, Tang DX, Fu JF. [Advances in the diagnosis and hormone replacement treatment of 46, XY disorders of sex development]. Zhonghua Nan Ke Xue 2016; 22:843-849. [PMID: 29071885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Disorders of sex development (DSD) is defined as a congenital condition or atypical development of the chromosomal, gonadal, or anatomic sex. The diagnosis, gender assignment, and treatment of DSD require the guidance from experienced multidisciplinary teams. So far there has been no consensus about it in China. Due to dysgenetic gonads, defects in sex steroid biosynthesis or action, or gonadectomy during the prepubertal years, those with DSD suffer from hypogonadism. The hormone replacement therapy of DSD aims at general physiological health and long-term prognosis as well as the avoidance of unnecessary genital and gonadal surgery. This review focuses on the advances in the studies of the diagnosis and hormone replacement therapy of 46,XY DSD.
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Affiliation(s)
- Hong-Juan Tian
- Department of Urology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China
| | - Jian-Wei Zhang
- Department of Pediatric, Women and Children's Health Care Hospital, Shaoxing, Zhejiang 312000, China
| | - De-Hua Wu
- Department of Urology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China
| | - Da-Xing Tang
- Department of Urology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China
| | - Jun-Fen Fu
- Department of Urology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China
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Elias-Assad G, Elias M, Kanety H, Pressman A, Tenenbaum-Rakover Y. Persistent Müllerian Duct Syndrome Caused by a Novel Mutation of an Anti-MüIlerian Hormone Receptor Gene: Case Presentation and Literature Review. Pediatr Endocrinol Rev 2016; 13:731-740. [PMID: 27464416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Persistent Müllerian duct syndrome (PMDS) is a rare genetic disorder of male internal sexual development defined as lack of regression of Müllerian derivatives in the 46XY male with normally virilized external genitalia and unilateral or bilateral cryptorchidism. Approximately 85% of all cases are caused by mutations in genes encoding anti-Müllerian hormone (AMH) or its receptor (AMHR2) with autosomal recessive transmission. This condition is frequently diagnosed incidentally, during surgical repair of inguinal hernia or cryptorchidism. There is no consensus on surgical approach: malignancy risk in the Müllerian duct remnant or undescended testis encourages early removal of the former and bilateral orchiopexy; however, removal of Müllerian structures can impair testicular and vas deferens blood supply, potentially causing infertility. Herein, we report on a male infant with PMDS caused by a novel homozygous missense mutation in AMHR2 (c.928C>T; p.Q310X), review the literature, and discuss the diverse clinical and surgical approaches to this condition.
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Koika V, Armeni AK, Georgopoulos NA. Delayed diagnosis of disorder of sex development (DSD) due to P450 oxidoreductase (POR) deficiency. Hormones (Athens) 2016; 15:277-282. [PMID: 27376429 DOI: 10.14310/horm.2002.1679] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 05/09/2016] [Indexed: 11/20/2022]
Abstract
CASE PRESENTATION A 36-year old man, operated on for cryptorchidism at the age of 8 years, was referred to the Outpatient Clinic of Reproductive Endocrinology for investigation of infertility. Clinical examination revealed ambiguous genitalia: penis 4-5 cm, testicular volume 2-3 ml, hypospadias, hypertrophic foreskin and scrotum bifida. Mild hypertension was confirmed. No skeletal malformations were detected. DESIGN Hormonal and electrolytic determinations as well as semen analysis were conducted. PCR of the coding regions of 17-hydroxylase/17,20 lyase (P450c17) and of P450 oxidoreductase (POR) genes was also performed. RESULTS Normal levels of electrolytes, low levels of androgens, high levels of gonadotropins and 17-hydroxyprogesterone as well as azoospermia were detected. Karyotype was shown to be 46,XY. Both hCG and ACTH stimulation significantly increased 17-hydroxyprogesterone with no increase in androgens. The diagnosis was congenital adrenal hyperplasia with apparent combined P450c17 and P450c21 deficiency due to mutations in the POR gene. Sequencing of the POR gene revealed: one deletion in exon 12 (Del 1696_1698delGTC >del531Valine) and one missense mutation in exon 7 (A259G) as well as two polymorphisms: rs1057868 (C/T A503V) and rs1057870 (G/A S572S) in exons 12 and 13, respectively. No nucleotide changes were detected in the 8 exons of P450c17. CONCLUSIONS Molecular findings were consistent with the diagnosis of P450 oxidoreductase deficiency. Despite this severe deficiency, skeletal malformations simulating Antley-Bixler syndrome, which usually characterize the most severe forms, were not confirmed. This discrepancy could be attributed to the differential impact of a POR variant on each one of the P450 enzymes.
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Affiliation(s)
- Vasiliki Koika
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, University Hospital, 26500, Patras, Greece
| | - Anastasia K Armeni
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, University Hospital, 26500, Patras, Greece
| | - Neoklis A Georgopoulos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, University Hospital, 26500, Patras, Greece.
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Huang Z, Ye J, Han L, Qiu W, Zhang H, Yu Y, Liang L, Gong Z, Gu X. Identification of five novel STAR variants in ten Chinese patients with congenital lipoid adrenal hyperplasia. Steroids 2016; 108:85-91. [PMID: 26827627 DOI: 10.1016/j.steroids.2016.01.016] [Citation(s) in RCA: 6] [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] [Received: 10/16/2015] [Revised: 01/01/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
Congenital lipoid adrenal hyperplasia (CLAH) is a rare autosomal recessive disorder caused by defective synthesis of all steroids. This disorder is characterized by 46,XY sex reversal, skin hyperpigmentation, early-onset adrenal crisis and enlarged adrenal with fatty accumulation. CLAH is caused by mutations in the STAR gene. The clinical features and STAR gene mutation spectrum of a large cohort of Chinese patients with CLAH were not reported previously. We performed clinical retrospective review and genetic analysis of the STAR gene in ten unrelated Chinese phenotypic female patients who were clinically diagnosed with CLAH and followed up in our hospital from 2006 to 2015. All ten patients, including two 46,XY females and eight 46,XX females, presented skin hyperpigmentation and early salt-wasting episode, and showed normal growth and development after steroid replacement treatment. Totally 20 mutant alleles containing 11 different STAR gene mutations were identified in these ten patients, including five novel variants (two missense and three null variants), all predicted to be pathogenic in bioinformatics analysis, and six mutations described in previous literature. Among these 11 mutations, a reported mutation c.772C>T and a novel variant c.707_708delinsCTT were most frequent, accounting for 35% and 15% of the total mutant alleles, respectively. This is the first report of a large Chinese cohort with CLAH, presenting the mutation spectrum of the STAR gene and two possible founder mutations in the Chinese population, which may contribute to better genetic counseling and prenatal diagnosis.
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MESH Headings
- Adrenal Hyperplasia, Congenital/diagnosis
- Adrenal Hyperplasia, Congenital/genetics
- Adrenal Hyperplasia, Congenital/therapy
- Asian People/genetics
- Carrier Proteins/chemistry
- Carrier Proteins/genetics
- Disorder of Sex Development, 46,XY/diagnosis
- Disorder of Sex Development, 46,XY/genetics
- Disorder of Sex Development, 46,XY/therapy
- Female
- Humans
- Infant
- Infant, Newborn
- Male
- Models, Molecular
- Mutation
- Mutation, Missense
- Protein Conformation
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Affiliation(s)
- Zhuo Huang
- Department of Pediatric Endocrinology/Genetics, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute for Pediatric Research, Shanghai 200092, China
| | - Jun Ye
- Department of Pediatric Endocrinology/Genetics, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute for Pediatric Research, Shanghai 200092, China
| | - Lianshu Han
- Department of Pediatric Endocrinology/Genetics, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute for Pediatric Research, Shanghai 200092, China
| | - Wenjuan Qiu
- Department of Pediatric Endocrinology/Genetics, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute for Pediatric Research, Shanghai 200092, China
| | - Huiwen Zhang
- Department of Pediatric Endocrinology/Genetics, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute for Pediatric Research, Shanghai 200092, China
| | - Yongguo Yu
- Department of Pediatric Endocrinology/Genetics, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute for Pediatric Research, Shanghai 200092, China
| | - Lili Liang
- Department of Pediatric Endocrinology/Genetics, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute for Pediatric Research, Shanghai 200092, China
| | - Zhuwen Gong
- Department of Pediatric Endocrinology/Genetics, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute for Pediatric Research, Shanghai 200092, China
| | - Xuefan Gu
- Department of Pediatric Endocrinology/Genetics, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute for Pediatric Research, Shanghai 200092, China.
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Cheng J, Lin R, Zhang W, Liu G, Sheng H, Li X, Zhou Z, Mao X, Liu L. Phenotype and molecular characteristics in 45 Chinese children with 5α-reductase type 2 deficiency from South China. Clin Endocrinol (Oxf) 2015; 83:518-26. [PMID: 25899528 DOI: 10.1111/cen.12799] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 03/26/2015] [Accepted: 04/16/2015] [Indexed: 11/27/2022]
Abstract
CONTEXT Affected by steroid 5α-reductase type 2 deficiency (5α-RD2), 46, XY individuals present divergent phenotypes characterized by undervirilization of male external genitalia. To identify the disorder, mutational analysis of 5α-reductase type 2 gene (SRD5A2) is a reliable approach. The genotype-phenotype relationship has not been elucidated. OBJECTIVE To improve the diagnosis and expand the knowledge of the disease, we collected and analysed relevant data of clinical diagnosis, biological investigation and molecular determination in 45 children with the SRD5A2 gene mutations from South China in our centre. SUBJECTS AND METHODS We studied a cohort of 45 Chinese children with SRD5A2 gene mutations. RESULTS Isolated microphallus (35·6%) and microphallus associated with various degrees of hypospadias (55·6%) were frequent phenotype. Female external genitalia with clitoromegaly (8·9%) were rare. 16 of 18 (88·9%) cases had hCG-stimulated T/DHT ratio above 10. In 45 patients, we identified 15 different mutations. Five have never been described: p.His90ThrfsX31, p.Gly21Arg, p.Gly149Asp, p.Arg145Leu and p.Gly66Arg. The p.Arg227Gln mutation was detected in 41 (91·1%) patients. The p.Leu89Val polymorphism was found in 38 (84·4%) patients. Homozygous mutations were presented in 16 (35·6%) patients, compound heterozygous mutations in 20 (44·4%) patients, compound heterozygous mutations alone with the p.Leu89Val polymorphism in nine (20·0%) patients. Exons 1 and 4 were most affected, and the number of mutant alleles per exon was 78·1% and 12·2%, respectively. CONCLUSIONS The study demonstrated a wide spectrum of phenotypes, biological profiles and genotypes in the children with 5α-RD2 from South China. The heterozygous mutation p.Arg227Gln is presumably a hot spot mutation and suggests a founder effect in the population of South China that may explain a moderate phenotype among our patients. Our report provides new insights into the molecular mechanism of 5α-RD2 and help to the diagnosis and treatment of this disease.
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Affiliation(s)
- Jing Cheng
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Ruizhu Lin
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Wen Zhang
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Guochang Liu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Huiying Sheng
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Xiuzhen Li
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Zhihong Zhou
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Xiaojian Mao
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Li Liu
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
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Al-Jurayyan NAM, Al Issa SDA, Al Nemri AMH, Al Otaibi HMN, Babiker AMI. The spectrum of 46XY disorders of sex development in a University centre in Saudi Arabia. J Pediatr Endocrinol Metab 2015; 28:1123-7. [PMID: 26030783 DOI: 10.1515/jpem-2014-0503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/02/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The term disorders of sex development (DSD) includes congenital conditions in which development of chromosomal, gonadal, or anatomical sex is atypical. The spectrum of the 46XY (DSD) is so broad. In this study, we reviewed the clinical spectrum of a cohort of patients with 46XY DSD in a tertiary institute in the Middle East over two decades. OBJECTIVE To define the clinical spectrum of 46XY DSD in a major teaching hospital, Riyadh, Saudi Arabia. MATERIALS AND METHODS This is a retrospective, case series hospital-based study. The case notes, laboratory investigations, and imaging studies were reviewed for patients with 46XY DSD over a 20 years period (1989-2010) at King Khalid University Hospital, Riyadh, Saudi Arabia. Molecular genetics were not available in all patients. RESULTS During the period under review; a total of 56 patients were seen with 46XY DSD due to variable etiologies. Androgen insensitivity syndromes (AIS) and 5-α-reductase deficiency were among the commonest (44.6%), with multiple siblings involvement within the family. Of these, 16 patients were showing variable degrees of insensitivity ranging between complete (n=5, 31.2%) and partial (n=11, 68.8%) insensitivity, whereas in nine patients the diagnosis of 5-α-reductase deficiency was entertained based on hormonal studies. Of interest to see was a high number of patients (n=14, 25%) either with a localized congenital anomalies such as the cloacal anomalies or generalized congenital malformations following the pattern of certain syndromes. CONCLUSION A wide spectrum of causes were noted. Androgen insensitivity syndrome was the commonest. In Saudi Arabia, where consanguineous mating is high, 5-α-reductase is also a common cause of 46XY DSD.
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Khattab A, Yuen T, Yau M, Domenice S, Frade Costa EM, Diya K, Muhuri D, Pina CE, Nishi MY, Yang AC, de Mendonça BB, New MI. Pitfalls in hormonal diagnosis of 17-beta hydroxysteroid dehydrogenase III deficiency. J Pediatr Endocrinol Metab 2015; 28:623-8. [PMID: 25536660 DOI: 10.1515/jpem-2014-0295] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 11/12/2014] [Indexed: 11/15/2022]
Abstract
Steroid 17β-hydroxysteroid dehydrogenase III (17β-HSD3) deficiency is a rare autosomal recessive disorder that usually presents in patients with a 46,XY karyotype with ambiguous genitalia at birth. The 17β-HSD3 enzyme, which is encoded by the HSD17B3 gene, converts gonadal delta-4 androstenedione (Δ4) to testosterone (T). Such 17β-HSD3 enzyme deficiency is expected to lead to an increased ratio of D4 to T when the patient undergoes a human chorionic gonadotropin stimulation (hCG) test. Two patients with 46,XY disorders of sexual differentiation were studied. Serum D4 and T levels were measured by HPLC tandem mass spectrometry. As one of the patients was born to consanguineous parents, we performed single nucleotide polymorphism (SNP) microarray to analyze regions of homozygosity (ROH). The HSD17B3 gene was sequenced using the Sanger method. Contrary to expectations, both patients demonstrated decreased D4/T ratio after hCG stimulation. Initial sequencing results for the androgen receptor or 5α-reductase were negative for mutations. ROH analysis identified HSD17B3 as a candidate gene that might cause the disease. Sanger sequencing of the HSD17B3 gene confirmed 17β-HSD3 deficiency in both patients. Serum D4/T ratios are not reliable parameters for the diagnosis of 17β-HSD3 deficiency. Molecular genetic analysis provides accurate diagnosis.
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Xie T, Zheng JP, Huang YL, Fan C, Wu DY, Tan MY, Li XZ, Cheng J, Liu L. [Clinical features and StAR gene mutations in children with congenital lipoid adrenal hyperplasia]. Zhongguo Dang Dai Er Ke Za Zhi 2015; 17:472-476. [PMID: 26014698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article reported the clinical manifestations, steroid profiles and adrenal ultrasound findings in two unrelated Chinese girls with lipoid congenital adrenal hyperplasia (LCAH). Direct DNA sequencing and restriction fragment length polymorphism (RFLP) analysis were used to identify the mutations of steroidogenic acute regulatory protein (StAR) gene. The two patients with 46,XX karyotype, presented hyperpigmentation, growth retardation, and hyponatremia. Steroid profiles analysis revealed elevated plasma adrenocorticotrophic hormone levels, decreased or normal serum cortisol levels and low levels of androgens. Ultrasound examinations revealed that enlarged adrenals in patient 1 and normal adrenals in patient 2. Direct DNA sequencing of StAR gene showed a reported homozygous for c.772C>T(p.Q258X) in patient 1. Compound heterozygous for c.367G>A(p.E123K) and IVS4+2T>A (both novel mutations) were found in patient 2, inherited from her mother and father respectively. The amino acid of mutant position of the novel p.E123K was highly conserved in ten different species and was predicted to have impacts on the structure and function of StAR protein by the PolyPhen-2 prediction software. RFLP analysis revealed three bands (670, 423 and 247 bp) in patient 2 and her father and two bands (423 and 247 bp) in her mother and 50 controls. It is concluded that LCAH should be considered in girls with early onset of adrenal insufficiency and that steroid profiles, karyotype analysis, adrenal ultrasound and StAR gene analysis may be helpful for the definite diagnosis of LCAH.
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Affiliation(s)
- Ting Xie
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou Medical College, Guangzhou 510623, China.
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46
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Baxter RM, Arboleda VA, Lee H, Barseghyan H, Adam MP, Fechner PY, Bargman R, Keegan C, Travers S, Schelley S, Hudgins L, Mathew RP, Stalker HJ, Zori R, Gordon OK, Ramos-Platt L, Pawlikowska-Haddal A, Eskin A, Nelson SF, Délot E, Vilain E. Exome sequencing for the diagnosis of 46,XY disorders of sex development. J Clin Endocrinol Metab 2015; 100:E333-44. [PMID: 25383892 PMCID: PMC4318895 DOI: 10.1210/jc.2014-2605] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Disorders of sex development (DSD) are clinical conditions where there is a discrepancy between the chromosomal sex and the phenotypic (gonadal or genital) sex of an individual. Such conditions can be stressful for patients and their families and have historically been difficult to diagnose, especially at the genetic level. In particular, for cases of 46,XY gonadal dysgenesis, once variants in SRY and NR5A1 have been ruled out, there are few other single gene tests available. OBJECTIVE We used exome sequencing followed by analysis with a list of all known human DSD-associated genes to investigate the underlying genetic etiology of 46,XY DSD patients who had not previously received a genetic diagnosis. DESIGN Samples were either submitted to the research laboratory or submitted as clinical samples to the UCLA Clinical Genomic Center. Sequencing data were filtered using a list of genes known to be involved in DSD. RESULTS We were able to identify a likely genetic diagnosis in more than a third of cases, including 22.5% with a pathogenic finding, an additional 12.5% with likely pathogenic findings, and 15% with variants of unknown clinical significance. CONCLUSIONS Early identification of the genetic cause of a DSD will in many cases streamline and direct the clinical management of the patient, with more focused endocrine and imaging studies and better-informed surgical decisions. Exome sequencing proved an efficient method toward such a goal in 46,XY DSD patients.
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Affiliation(s)
- Ruth M Baxter
- Departments of Human Genetics (R.M.B., V.A.A., H.B., A.E., S.F.N., E.D., E.V.) and Pathology and Laboratory Medicine (V.A.A., H.L., S.F.N.), David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California 90095; Department of Pediatrics (M.P.A.), University of Washington, Seattle, Washington 98195; Department of Endocrinology (P.Y.F.), Seattle Children's Hospital, Seattle, Washington 98105; Nassau University Medical Center (R.B.), East Meadow, New York 11554; Departments of Pediatrics and Human Genetics (C.K.), Ann Arbor, Michigan 48109; The Children's Hospital Colorado (S.T.), Aurora, Colorado 80045; Division of Medical Genetics (S.S., L.H.), Stanford University, Lucile Packard Children's Hospital, Stanford, California 94305; TriStar Children's Specialists (R.P.M.), Nashville, Tennessee 37203; Division of Pediatric Genetics and Metabolism (H.J.S., R.Z.), University of Florida, Gainesville, Florida 32610; Cedars-Sinai Medical Center (O.K.G.), Los Angeles, California 90048; Children's Hospital of Los Angeles (L.R.-P.), Los Angeles, California 90027; and Departments of Pediatrics (A.P.-H., E.D., E.V.) and Urology (E.V.), David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California 90095
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47
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Kovachev SM, Nikolov SD, Mihova AP. Uterine leiomyoma in a man with persistent Müllerian duct syndrome and seminoma. Isr Med Assoc J 2014; 16:735-737. [PMID: 25558708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
MESH Headings
- Chemotherapy, Adjuvant
- Disorder of Sex Development, 46,XY/diagnosis
- Disorder of Sex Development, 46,XY/physiopathology
- Disorder of Sex Development, 46,XY/surgery
- Female
- Humans
- Hysterectomy/methods
- Laparotomy/methods
- Leiomyoma/pathology
- Male
- Middle Aged
- Neoplasms, Germ Cell and Embryonal/pathology
- Neoplasms, Germ Cell and Embryonal/surgery
- Orchiectomy/methods
- Radiotherapy, Adjuvant
- Seminoma/pathology
- Seminoma/surgery
- Testicular Neoplasms/pathology
- Testicular Neoplasms/surgery
- Treatment Outcome
- Uterine Neoplasms/pathology
- Uterine Neoplasms/surgery
- Uterus/abnormalities
- Uterus/pathology
- Uterus/surgery
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Affiliation(s)
- Stefan M Kovachev
- Department of General and oncologic Gynecology, Military Medical Academy, Sofia, Bulgaria.
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Hafez M, El Dayem SMA, El Mougy F, Atef A, Kandil M, Galal A, Al Hamid AA. The role of anti-Mullerian and inhibin B hormones in the evaluation of 46,XY disorders of sex development. J Pediatr Endocrinol Metab 2014; 27:891-9. [PMID: 24854526 DOI: 10.1515/jpem-2013-0355] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 04/17/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the sensitivity and specificity of anti-Mullerian hormone (AMH) and inhibin B for diagnosis of 46,XY disorders of sex development (DSD). PATIENTS AND METHODS The study included 43 patients of 46,XY DSD and compared them with 43 healthy, male, age matched controls. All patients underwent karyotyping, assessment of testosterone, dihydrotestosterone (DHT) and Δ4-androstendione (Δ4A) basal and after human chorionic gonadotropin (HCG) testing. Basal dehydroepiandrosterone (DHEA) was measured. Ultrasonograghy was also done and some cases underwent laparoscopy or gonadal biopsies. Basal AMH and inhibin B were measured in both cases and controls. RESULTS The mean age of patients was 5.16±4.24 years. There were significant correlations between basal AMH and HCG stimulated testosterone and DHT (r=0.64; p<0.001 and r=0.52; p<0.001, respectively). Also, significant positive correlations were found between inhibin B and HCG as well as stimulated testosterone and DHT (r=0.62; p<0.001 and r=0.44; p=0.003, respectively). A highly significant correlation was found between AMH and inhibin B (r=0.78; p<0.001). The sensitivity of AMH was (96.6%), specificity (60.7%), NPV (89.5%) and PPV (83.6%). Best cut-off value was (27.11 IU/mL) while overall accuracy was (85%). The sensitivity of inhibin B was (96.6%), specificity (67.9%), NPV (90.5%), PPV (86.2%), and best cut-off value was (41.9 IU/mL) with an overall accuracy (87%). CONCLUSION AMH and inhibin B are valuable, and reliable noninvasive parameters for the detection of functioning testicular tissues in prepubertal patients.
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Abstract
BACKGROUND Leydig cell hypoplasia is a rare autosomal recessive condition that interferes with the normal development of male external genitalia in 46,XY individuals. It is mediated by mutations in the lutropin/choriogonadotropin receptor gene, resulting in the impairment of either the binding of hormone or signal transduction. OBJECTIVE/DESIGN We report a 32-year-old female patient with severe Leydig cell hypoplasia due to a novel homozygote nonsense mutation in exon 10 (c.907C>T, p.Gln303Ter) of the lutropin/choriogonadotropin receptor gene. Interestingly, a second mutation was found (c.935A>G, p.Asn312Ser) downstream of the disruption of the gene sequence. CONCLUSIONS This case report demonstrates the coexistence of a novel homozygote nonsense mutation with a second mutation in the same hormone binding domain, expanding the genotypic spectrum of lutropin-choriogonadotropic hormone receptor gene mutations. The first diagnosis of this mutation in an adult 46,XY female patient from Morocco underlines the importance of thorough clinical and genetic examination, not only in pre- and post-pubertal children but also in adults originating from conservative socio-cultural backgrounds.
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Affiliation(s)
- Anastasia P Athanasoulia
- Department of Endocrinology, Internal Medicine and Clinical Chemistry, Max-Planck-Institute of Psychiatry; Munich; Germany
| | - Günter K Stalla
- Department of Endocrinology, Internal Medicine and Clinical Chemistry, Max-Planck-Institute of Psychiatry; Munich; Germany
| | - Matthias K Auer
- Department of Endocrinology, Internal Medicine and Clinical Chemistry, Max-Planck-Institute of Psychiatry; Munich; Germany
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50
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Abstract
Disorders of sex development (DSD) among 46,XY individuals are rare and challenging conditions. Abnormalities of karyotype, gonadal formation, androgen synthesis, and androgen action are responsible for the multiple disorders that result in undervirilization during development. Phenotypic appearance and timing of presentation are quite variable. The focus of treatment has shifted from early gender assignment and corrective surgery to careful diagnosis, proper education of patients and their families, and individualized treatment by a multi-disciplinary team. The modern management of these patients is difficult and controversial. Conflicting data on long-term outcomes of these individuals have been reported in the literature. The various etiologies of 46,XY DSD, current approaches to diagnosis and treatment, and reported long-term results are reviewed.
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MESH Headings
- Androgen-Insensitivity Syndrome/metabolism
- Disorder of Sex Development, 46,XY/diagnosis
- Disorder of Sex Development, 46,XY/etiology
- Disorder of Sex Development, 46,XY/physiopathology
- Disorder of Sex Development, 46,XY/therapy
- Female
- Genitalia, Female/surgery
- Genitalia, Male/surgery
- Gonadal Dysgenesis, 46,XY/embryology
- Gonadal Dysgenesis, 46,XY/genetics
- Humans
- Male
- Patient Care Team
- Plastic Surgery Procedures
- Treatment Outcome
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Affiliation(s)
- Eric Z Massanyi
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Bloomberg 7302, Baltimore, MD 21287, USA.
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