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Cadet P. Intersex Pretenders. Arch Sex Behav 2024; 53:1667-1679. [PMID: 38744731 DOI: 10.1007/s10508-024-02854-0] [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] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/08/2024] [Accepted: 03/09/2024] [Indexed: 05/16/2024]
Abstract
False claims of having an intersex condition have been observed in print, video, Internet media, and in live presentations. Claims of being intersexed in publicly accessible media were examined and evidence that they were false was considered sufficiently conclusive in 37 cases. Falsity was most often detected due to medical implausibility and/or inconsistency, but sometimes also using information from third-party or published sources. The majority, 26/37, of cases were natal males; 11/37 were natal females. Almost all (34/37) were transgendered, living, or aspiring to live, in their non-natal sex or as socially intergender. The most commonly claimed diagnosis was ovotesticular disorder ("true hermaphroditism") due to chimerism, an actually uncommon cause of authentic intersexuality. Motivations for pretending to be intersexed were inferred from statements and behaviors and were varied. Some such pretenders appear to be avoiding the external or internalized stigma of an actual transgendered condition. Some appear, similarly to persons with factitious disorder, to be seeking attention and/or the role of a sick, disadvantaged, or victimized person. Some showed evidence of paraphilia, most frequently autogynephilia, and, in several cases, paraphilic diaperism. For some cases, such claims had been accepted as authentic by journalists or social scientists and repeated as true in published material.
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Atencia Goñi J, Orera Clemente M, Del Valle Diéguez MJ, González Fernández L, González Albarrán O. Clinical report of Bosma arhinia microphthalmia syndrome with a new variant on SMCHD1 gene. A case report. ENDOCRINOL DIAB NUTR 2024; 71:138-143. [PMID: 38555111 DOI: 10.1016/j.endien.2024.03.011] [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: 11/02/2023] [Accepted: 12/29/2023] [Indexed: 04/02/2024]
Abstract
The Bosma syndrome (BAMS: Bosma arhinia microphthalmia syndrome) is a condition first described in 1972. Since then, several reviews have published the cases looking for diagnostic criteria and associated genetic alterations. The mutation in the SMCHD1 gene (Structural Maintenance of Chromosomes flexible Hinge Domain containing protein 1) seems to explain a part of the development of the phenotype. Not all cases show the same alterations or meet the classic diagnostic criteria, and few have undergone genetic analysis. We present a case with a new variant in this gene and an update of the literature on this syndrome with the aim of improving the diagnosis and follow-up of these patients.
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Affiliation(s)
- José Atencia Goñi
- Department of Endocrinology and Nutrition, HGU Gregorio Marañón, Madrid, Spain.
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3
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Rjiba K, Slimani W, Gaddas M, Hassine IH, Jelloul A, Khelifa HB, El Amri F, Zaouali M, Mcelreavey K, Saad A, Mougou-Zerelli S. Anomalies in Human Sex Determination: Usefulness of a Combined Cytogenetic Approach to Characterize an Additional Case with Xp Functional Disomy Associated with 46,XY Gonadal Dysgenesis. J Clin Res Pediatr Endocrinol 2023; 15:25-34. [PMID: 35984215 PMCID: PMC9976160 DOI: 10.4274/jcrpe.galenos.2022.2022-3-15] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Disorders of sexual development (DSD) are a heterogeneous group of genital defects affecting chromosomal, gonadal and anatomical sex. 46,XY DSD is a subset of DSD which covers a wide range of phenotypes in which 46,XY gonadal dysgenesis (GD) is the most severe form. In this study, we report on the clinical and molecular cytogenetic findings of a study on a Tunisian girl with the syndromic form of 46,XY DSD. METHODS This case was a phenotypic female patient having several congenital anomalies including growth retardation. Karyotype, fluorescence in situ hybridization and array Comparative Genome Hybridization (array CGH) were performed. RESULTS The proband exhibited a de-novo 46,X,der(Y) karyotype. Array CGH revealed a pathogenic 27.5Mb gain of an Xp21.2 chromosome segment leading to Xp functional disomy. No deletion was observed in the Y-chromosome. The duplicated region encompassed the NR0B1 (DAX1) and MAGEB genes, located within the dosage sensitive sex (DSS) reversal locus, known as promote genes responsible for human sex reversal and testis repression. The extra-dosage and interactions of these genes with different specific genes could result in the impairment of the male sex pathway. Over-dosage of KAL1 and IL1RAPL1 genes fall within the somatic features observed in the patient. CONCLUSION To the best of our knowledge, we report on the fourth case of Xp21.2-pter duplication within Xp;Yp translocation associated with XY GD. Our findings suggest that when duplicated, the NR0B1 and MAGEB genes could be a major cause of XY GD. Therefore, we emphasize the usefulness of a combined cytogenetic approach in order to provide an accurate genetic diagnosis for those patients having syndromic XY DSD in a clinical setting.
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Affiliation(s)
- Khouloud Rjiba
- Farhat Hached University Hospital, Molecular Genetics and Biology of Reproduction, Laboratory of Human Cytogenetics, Sousse; Higher Institute of Biotechnology of Monastir, University of Monastir, Monastir; Université de Sousse, Faculté de Médecine de Sousse, Unité de Services Communs en Génétique Humaine, Sousse, Tunisia
| | - Wafa Slimani
- Farhat Hached University Hospital, Molecular Genetics and Biology of Reproduction, Laboratory of Human Cytogenetics; Université de Sousse, Faculté de Médecine de Sousse, Unité de Services Communs en Génétique Humaine, Sousse, Tunisia
| | - Meriem Gaddas
- Sousse University, Faculty of Medicine of Sousse, Laboratory of Physiology and Functional Explorations, Sousse, Tunisia
| | - Ikbel Hadj Hassine
- University of Monastir, Higher Institute of Biotechnology, Monastir, Tunisia
| | - Afef Jelloul
- Farhat Hached University Hospital, Molecular Genetics and Biology of Reproduction, Laboratory of Human Cytogenetics, Sousse, Tunisia
| | - Hela Ben Khelifa
- Farhat Hached University Hospital, Molecular Genetics and Biology of Reproduction, Laboratory of Human Cytogenetics, Sousse, Tunisia
| | | | - Monia Zaouali
- Sousse University, Faculty of Medicine of Sousse, Laboratory of Physiology and Functional Explorations, Sousse, Tunisia
| | | | - Ali Saad
- Farhat Hached University Hospital, Molecular Genetics and Biology of Reproduction, Laboratory of Human Cytogenetics; Université de Sousse, Faculté de Médecine de Sousse, Unité de Services Communs en Génétique Humaine, Sousse, Tunisia
| | - Soumaya Mougou-Zerelli
- Farhat Hached University Hospital, Molecular Genetics and Biology of Reproduction, Laboratory of Human Cytogenetics; Université de Sousse, Faculté de Médecine de Sousse, Unité de Services Communs en Génétique Humaine, Sousse, Tunisia,* Address for Correspondence: Farhat Hached University Hospital, Molecular Genetics and Biology of Reproduction, Laboratory of Human Cytogenetics; Université de Sousse, Faculté de Médecine de Sousse, Unité de Services Communs en Génétique Humaine, Sousse, Tunisia Phone: +00216 98 480 488 E-mail:
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Barros BA, Guaragna MS, Fabbri-Scallet H, Palandi de Mello M, Guerra-Júnior G, Maciel-Guerra AT. Are NR5A1 Variations a Frequent Cause of 46,XX Ovotesticular Disorders of Sex Development? Analysis from a Single Center and Systematic Review. Sex Dev 2023; 16:242-251. [PMID: 36657429 DOI: 10.1159/000526036] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 07/11/2022] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Ovotesticular disorder of sex development (OT-DSD) is a rare condition defined by concomitance of testicular tissue and ovarian tissue (containing follicles) in the same individual. In SRY-negative 46,XX OT-DSD, the presence of testicular tissue may be due to variations in NR5A1. Our aims were to search for NR5A1 variants in SRY-negative 46,XX OT-DSD patients and to perform a systematic review on the contribution of NR5A1 variations to 46,XX OT-DSD. METHODS Sanger sequencing of NR5A1 was performed in seven SRY-negative 46,XX OT-DSD patients: five simplex cases and two with another sibling with a 46,XX DSD. Systematic review of original studies on NR5A1 sequencing of 46,XX OT-DSD patients was performed according to PRISMA-P guideline. Case reports were selected for analysis of clinical features. Individuals with NR5A1-associated testicular DSD were not included. RESULTS Sanger sequencing of NR5A1 did not reveal pathogenic variants among our patients. Our cohort was included in this systematic review with seven other articles, totalizing fifty-six 46,XX OT-DSD patients investigated by Sanger or whole-exome sequencing. From them, three NR5A1 pathogenic variants were identified (5% of the cases). Clinical analysis of these 3 cases and 5 case reports revealed: predominance of ovotestis (13/16 gonads) and bilateral OT-DSD (5/8 cases). CONCLUSION The etiology of most 46,XX OT-DSD cases remains elusive, highlighting the importance of a deeper molecular investigation.
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Affiliation(s)
- Beatriz Amstalden Barros
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas (UNICAMP), Campinas, Brazil.,Department of Pediatrics, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Mara Sanches Guaragna
- Center for Molecular Biology and Genetic Engineering (CBMEG), State University of Campinas (UNICAMP), Campinas, Brazil
| | - Helena Fabbri-Scallet
- Center for Molecular Biology and Genetic Engineering (CBMEG), State University of Campinas (UNICAMP), Campinas, Brazil
| | - Maricilda Palandi de Mello
- Center for Molecular Biology and Genetic Engineering (CBMEG), State University of Campinas (UNICAMP), Campinas, Brazil
| | - Gil Guerra-Júnior
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas (UNICAMP), Campinas, Brazil.,Department of Pediatrics, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Andréa Trevas Maciel-Guerra
- Interdisciplinary Group for the Study of Sex Determination and Differentiation (GIEDDS), State University of Campinas (UNICAMP), Campinas, Brazil.,Department of Medical Genetics and Genomic Medicine, State University of Campinas (UNICAMP), Campinas, Brazil
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5
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Ehua AM, Moulot MO, Agbara KS, Enache T, Bankole SR. Disorders of sex development: Challenges in a low-resource country. Arch Pediatr 2023; 30:10-13. [PMID: 36462990 DOI: 10.1016/j.arcped.2022.09.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 06/15/2022] [Accepted: 09/24/2022] [Indexed: 12/05/2022]
Abstract
AIM We aimed to identify the challenges in the management of sexual development abnormalities in a low-resource country. METHODS The study was retrospective from January 2000 to December 2017 based on patient records from two pediatric surgery departments. Epidemiological, clinical, paraclinical, treatment, and outcome data were studied. RESULTS We collected data on 13 patients (average age = 7.95 years). The sex of rearing was as follows: three females (23%), 10 males (77%). Atypical genitalia other than hypospadias represented the reason for consultation in 92% of the cases. We could not find complete hormonal analyses; testosterone levels were studied in 69.23% of cases. We found the following disorders of sexual development (DSD): four patients with 46,XX karyotype (30.77%), eight patients with 46,XY karyotype (61.53%), and one patient with 46,XX/XY karyotype. Four patients had medical treatment only, four had surgical treatment only, and one patient had medical and surgical treatment. The medical treatment comprised topical administration of androgen. The surgical treatment consisted of feminizing genitoplasty for one patient and masculinizing genital surgeries for two patients. Six of the 13 patients were lost to follow-up. CONCLUSION The socioeconomic difficulties of the population and the lack of access to basic diagnostic and paraclinical methods, coupled with the negative cultural representations of the pathology, constitute the challenges in the management of DSD in our practice.
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Affiliation(s)
- A M Ehua
- Department of Pediatric Surgery Treichville Teaching Hospital Abidjan, Côte d'Ivoire 01 BP V 03 Abidjan 01.
| | - M O Moulot
- Department of Pediatric Surgery Treichville Teaching Hospital Abidjan, Côte d'Ivoire 01 BP V 03 Abidjan 01
| | - K S Agbara
- Department of Pediatric Surgery Treichville Teaching Hospital Abidjan, Côte d'Ivoire 01 BP V 03 Abidjan 01
| | - T Enache
- Clinical Emergency Hospital for Children, Grigore Alexandrescu Bucharest, Romania
| | - S R Bankole
- Department of Pediatric Surgery Treichville Teaching Hospital Abidjan, Côte d'Ivoire 01 BP V 03 Abidjan 01
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Zhao Y, Gardner EJ, Tuke MA, Zhang H, Pietzner M, Koprulu M, Jia RY, Ruth KS, Wood AR, Beaumont RN, Tyrrell J, Jones SE, Lango Allen H, Day FR, Langenberg C, Frayling TM, Weedon MN, Perry JRB, Ong KK, Murray A. Detection and characterization of male sex chromosome abnormalities in the UK Biobank study. Genet Med 2022; 24:1909-1919. [PMID: 35687092 DOI: 10.1016/j.gim.2022.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 01/31/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The study aimed to systematically ascertain male sex chromosome abnormalities, 47,XXY (Klinefelter syndrome [KS]) and 47,XYY, and characterize their risks of adverse health outcomes. METHODS We analyzed genotyping array or exome sequence data in 207,067 men of European ancestry aged 40 to 70 years from the UK Biobank and related these to extensive routine health record data. RESULTS Only 49 of 213 (23%) of men whom we identified with KS and only 1 of 143 (0.7%) with 47,XYY had a diagnosis of abnormal karyotype on their medical records or self-report. We observed expected associations for KS with reproductive dysfunction (late puberty: risk ratio [RR] = 2.7; childlessness: RR = 4.2; testosterone concentration: RR = -3.8 nmol/L, all P < 2 × 10-8), whereas XYY men appeared to have normal reproductive function. Despite this difference, we identified several higher disease risks shared across both KS and 47,XYY, including type 2 diabetes (RR = 3.0 and 2.6, respectively), venous thrombosis (RR = 6.4 and 7.4, respectively), pulmonary embolism (RR = 3.3 and 3.7, respectively), and chronic obstructive pulmonary disease (RR = 4.4 and 4.6, respectively) (all P < 7 × 10-6). CONCLUSION KS and 47,XYY were mostly unrecognized but conferred substantially higher risks for metabolic, vascular, and respiratory diseases, which were only partially explained by higher levels of body mass index, deprivation, and smoking.
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Affiliation(s)
- Yajie Zhao
- MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, Cambridge University, Cambridge, United Kingdom
| | - Eugene J Gardner
- MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, Cambridge University, Cambridge, United Kingdom
| | - Marcus A Tuke
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Royal Devon & Exeter Hospital, Exeter, United Kingdom
| | - Huairen Zhang
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Royal Devon & Exeter Hospital, Exeter, United Kingdom
| | - Maik Pietzner
- MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, Cambridge University, Cambridge, United Kingdom; Computational Medicine, Berlin Institute of Health (BIH) at Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Mine Koprulu
- MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, Cambridge University, Cambridge, United Kingdom
| | - Raina Y Jia
- MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, Cambridge University, Cambridge, United Kingdom
| | - Katherine S Ruth
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Royal Devon & Exeter Hospital, Exeter, United Kingdom
| | - Andrew R Wood
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Royal Devon & Exeter Hospital, Exeter, United Kingdom
| | - Robin N Beaumont
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Royal Devon & Exeter Hospital, Exeter, United Kingdom
| | - Jessica Tyrrell
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Royal Devon & Exeter Hospital, Exeter, United Kingdom
| | - Samuel E Jones
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Royal Devon & Exeter Hospital, Exeter, United Kingdom; Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Hana Lango Allen
- MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, Cambridge University, Cambridge, United Kingdom
| | - Felix R Day
- MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, Cambridge University, Cambridge, United Kingdom
| | - Claudia Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, Cambridge University, Cambridge, United Kingdom; Computational Medicine, Berlin Institute of Health (BIH) at Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Timothy M Frayling
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Royal Devon & Exeter Hospital, Exeter, United Kingdom
| | - Michael N Weedon
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Royal Devon & Exeter Hospital, Exeter, United Kingdom
| | - John R B Perry
- MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, Cambridge University, Cambridge, United Kingdom
| | - Ken K Ong
- MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, Cambridge University, Cambridge, United Kingdom.
| | - Anna Murray
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Royal Devon & Exeter Hospital, Exeter, United Kingdom.
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7
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Batista RL, Mendonca BB. The Molecular Basis of 5α-Reductase Type 2 Deficiency. Sex Dev 2022; 16:171-183. [PMID: 35793650 DOI: 10.1159/000525119] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/13/2022] [Indexed: 11/19/2022] Open
Abstract
The 5α-reductase type 2 enzyme catalyzes the conversion of testosterone into dihydrotestosterone, playing a crucial role in male development. This enzyme is encoded by the SRD5A2 gene, which maps to chromosome 2 (2p23), consists of 5 exons and 4 introns, and encodes a 254 amino acid protein. Disruptions in this gene are the molecular etiology of a subgroup of differences of sex development (DSD) in 46,XY patients. Affected individuals present a large range of external genitalia undervirilization, ranging from almost typically female external genitalia to predominantly typically male external genitalia with minimal undervirilization, including isolated micropenis. This is an updated review of the implication of the SRD5A2 gene in 5α-reductase type 2 enzyme deficiency. For that, we identified 451 cases from 48 countries of this particular 46,XY DSD from the literature with reported variants in the SRD5A2 gene. Herein, we present the SRD5A2 mutational profile, the SRD5A2 polymorphisms, and the functional studies related to SRD5A2 variants to detail the molecular etiology of this condition.
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Affiliation(s)
- Rafael L Batista
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia, do Departamento de Clínica Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Endocrine Oncology Unit, Instituto do Câncer do Estado de São Paulo, ICESP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Berenice B Mendonca
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia, do Departamento de Clínica Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Huen KH, Holzman SA, Davis-Dao CA, Wehbi EJ, Khoury AE. Taking "Trans-ano-rectal" out of ASTRA: An anterior sagittal approach without splitting the rectum. J Pediatr Urol 2022; 18:96-97. [PMID: 34980557 DOI: 10.1016/j.jpurol.2021.12.007] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/25/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022]
Abstract
The anterior sagittal trans-ano-rectal approach (ASTRA) provides excellent exposure to the urethra and vagina for partial or total urogenital sinus mobilization and subsequent reconstruction for patients with urogenital sinus anomalies. It is a frequent approach to reconstruction for children with a high confluence. However, the division of the anterior anal external sphincter and the rectal wall in the ASTRA incurs morbidity, which include fecal incontinence if one veers from the midline, and increased risk of wound infection due to fecal soilage. We demonstrate a modified technique to the ASTRA without dividing the anterior anal sphincter and rectal wall, with achievement of comparable exposure and excellent vaginal mobilization and length.
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Affiliation(s)
- Kathy H Huen
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California Irvine School of Medicine, Orange CA, USA.
| | - Sarah A Holzman
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California Irvine School of Medicine, Orange CA, USA
| | - Carol A Davis-Dao
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA
| | - Elias J Wehbi
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California Irvine School of Medicine, Orange CA, USA
| | - Antoine E Khoury
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California Irvine School of Medicine, Orange CA, USA
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9
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Okashita N, Tachibana M. Transcriptional Regulation of the Y-Linked Mammalian Testis-Determining Gene SRY. Sex Dev 2021; 15:351-359. [PMID: 34583357 DOI: 10.1159/000519217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/12/2021] [Indexed: 11/19/2022] Open
Abstract
Mammalian male sex differentiation is triggered during embryogenesis by the activation of the Y-linked testis-determining gene SRY. Since insufficient or delayed expression of SRY results in XY gonadal sex reversal, accurate regulation of SRY is critical for male development in XY animals. In humans, dysregulation of SRY may cause disorders of sex development. Mouse Sry is the most intensively studied mammalian model of sex determination. Sry expression is controlled in a spatially and temporally stringent manner. Several transcription factors play a key role in sex determination as trans-acting factors for Sry expression. In addition, recent studies have shown that several epigenetic modifications of Sry are involved in sex determination as cis-acting factors for Sry expression. Herein, we review the current understanding of transcription factor- and epigenetic modifier-mediated regulation of SRY/Sry expression.
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Affiliation(s)
- Naoki Okashita
- Graduate School of Frontier Biosciences, Osaka University, Osaka, Japan
| | - Makoto Tachibana
- Graduate School of Frontier Biosciences, Osaka University, Osaka, Japan
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10
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Zidoune H, Martinerie L, Tan DS, Askari M, Rezgoune D, Ladjouze A, Boukri A, Benelmadani Y, Sifi K, Abadi N, Satta D, Rastari M, Seresht-Ahmadi M, Bignon-Topalovic J, Mazen I, Leger J, Simon D, Brauner R, Totonchi M, Jauch R, Bashamboo A, McElreavey K. Expanding DSD Phenotypes Associated with Variants in the DEAH-Box RNA Helicase DHX37. Sex Dev 2021; 15:244-252. [PMID: 34293745 DOI: 10.1159/000515924] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/16/2021] [Indexed: 11/19/2022] Open
Abstract
Missense variants in the RNA-helicase DHX37 are associated with either 46,XY gonadal dysgenesis or 46,XY testicular regression syndrome (TRS). DHX37 is required for ribosome biogenesis, and this subgroup of XY DSD is a new human ribosomopathy. In a cohort of 140 individuals with 46,XY DSD, we identified 7 children with either 46,XY complete gonadal dysgenesis or 46,XY TRS carrying rare or novel DHX37 variants. A novel p.R390H variant within the RecA1 domain was identified in a girl with complete gonadal dysgenesis. A paternally inherited p.R487H variant, previously associated with a recessive congenital developmental syndrome, was carried by a boy with a syndromic form of 46,XY DSD. His phenotype may be explained in part by a novel homozygous loss-of-function variant in the NGLY1 gene, which causes a congenital disorder of deglycosylation. Remarkably, a homozygous p.T477H variant was identified in a boy with TRS. His fertile father had unilateral testicular regression with typical male genital development. This expands the DSD phenotypes associated with DHX37. Structural analysis of all variants predicted deleterious effects on helicase function. Similar to all other known ribosomopathies, the mechanism of pathogenesis is unknown.
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Affiliation(s)
- Housna Zidoune
- Human Developmental Genetics Unit, CNRS UMR 3738, Institut Pasteur, Paris, France.,Department of Animal Biology, Laboratory of Molecular and Cellular Biology, University Frères Mentouri Constantine 1, Constantine, Algeria.,Department of Medicine, Laboratory of Biology and Molecular Genetics, University Salah Boubnider Constantine 3, Constantine, Algeria
| | - Laetitia Martinerie
- Assistance Publique-Hôpitaux de Paris Université de Paris, Robert Debré University Hospital, Endocrinology-Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Paris, France
| | - Daisylyn S Tan
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Masomeh Askari
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Djalila Rezgoune
- Department of Animal Biology, Laboratory of Molecular and Cellular Biology, University Frères Mentouri Constantine 1, Constantine, Algeria.,Department of Medicine, Laboratory of Biology and Molecular Genetics, University Salah Boubnider Constantine 3, Constantine, Algeria
| | | | - Asma Boukri
- Department of Endocrinology and Diabetology, CHU Ibn Badis Constantine, Constantine, Algeria
| | - Yasmina Benelmadani
- Department of Medicine, Laboratory of Biology and Molecular Genetics, University Salah Boubnider Constantine 3, Constantine, Algeria
| | - Karima Sifi
- Department of Medicine, Laboratory of Biology and Molecular Genetics, University Salah Boubnider Constantine 3, Constantine, Algeria
| | - Noureddine Abadi
- Department of Medicine, Laboratory of Biology and Molecular Genetics, University Salah Boubnider Constantine 3, Constantine, Algeria
| | - Dalila Satta
- Department of Animal Biology, Laboratory of Molecular and Cellular Biology, University Frères Mentouri Constantine 1, Constantine, Algeria.,Department of Medicine, Laboratory of Biology and Molecular Genetics, University Salah Boubnider Constantine 3, Constantine, Algeria
| | - Mandana Rastari
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mehrshad Seresht-Ahmadi
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | | | - Inas Mazen
- Genetics Department, National Research Center, Cairo, Egypt
| | - Juliane Leger
- Assistance Publique-Hôpitaux de Paris Université de Paris, Robert Debré University Hospital, Endocrinology-Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Paris, France
| | - Dominique Simon
- Assistance Publique-Hôpitaux de Paris Université de Paris, Robert Debré University Hospital, Endocrinology-Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Paris, France
| | - Raja Brauner
- Fondation Ophtalmologique Adolphe de Rothschild and Université Paris Descartes, Paris, France
| | - Mehdi Totonchi
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ralf Jauch
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Anu Bashamboo
- Human Developmental Genetics Unit, CNRS UMR 3738, Institut Pasteur, Paris, France
| | - Kenneth McElreavey
- Human Developmental Genetics Unit, CNRS UMR 3738, Institut Pasteur, Paris, France
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Hebenstreit D, Ahmed SF, Krone N, Krall C, Bryce J, Alvi S, Ortolano R, Lima M, Birkebaek N, Bonfig W, Claahsen van der Grinten H, Costa EC, Poyrazoglu S, de Vries L, Flück CE, Guran T, Bugrul F, Güven A, Iotova V, Koehler B, Schröder JT, Konrad D, Gevers E, Krone R, Milenkovic T, Vieites A, Ross R, Tadokoro Cuccaro R, Hughes I, Acerini C, Springer A. Surgical Practice in Girls with Congenital Adrenal Hyperplasia: An International Registry Study. Sex Dev 2021; 15:229-235. [PMID: 34350892 DOI: 10.1159/000517055] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/29/2021] [Indexed: 11/19/2022] Open
Abstract
In this article international trends in surgical practice in girls with congenital adrenal hyperplasia (CAH) are evaluated. All cases that had been classified in the I-CAH/I-DSD registry as 46,XX CAH and who were born prior to 2017 were identified. Centers were approached to obtain information on surgical decision making. Of the 330 included participants, 208 (63.0%) presented within the first month of life, and 326 (98.8%) cases were assigned female. Genital surgery had been performed in 250 (75.8%). A total of 64.3, 89.2, and 96.8% of cases residing in Europe, South America and Asia, respectively, had at least one surgery. In a logistic regression model for the probability of surgery before the second birthday (early surgery) over time an increase of probability for early vaginal surgery could be identified, but not for clitoral surgery or both surgeries combined. Genitoplasty in girls with CAH remains controversial. This large international study provides a snapshot of current practice and reveals geographical and temporal differences. Fewer surgeries were reported for Europe, and there seems to be a significant trend towards aiming for vaginal surgery within the first 2 years of life.
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Affiliation(s)
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, United Kingdom
| | - Nils Krone
- University of Sheffield, Sheffield, United Kingdom
| | - Christoph Krall
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Jillian Bryce
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, United Kingdom
| | - Sabah Alvi
- Paediatric Endocrinology, Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Rita Ortolano
- Department of Medical and Surgical Sciences, Pediatric Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Mario Lima
- Department of Medical and Surgical Sciences, Pediatric Surgery Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Niels Birkebaek
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Walter Bonfig
- Department of Pediatrics TU Munich, Munich, Germany
- Klinikum Wels-Grieskirchen, Wels-Grieskirchen, Austria
| | - Hedi Claahsen van der Grinten
- Department of Paediatric Endocrinology, Radboud University Amalia Childers Hospital Medical Centre, Nijmegen, The Netherlands
| | - Eduardo Correa Costa
- Pediatric Surgery Service, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, Brazil
| | - Sukran Poyrazoglu
- Istanbul Faculty of Medicine, Department of Paediatrics, Paediatric Endocrinology Unit, Istanbul University, Istanbul, Turkey
| | - Liat de Vries
- The Jesse and Sara Lea Shafer Institute of Endocrinology and Diabetes, Schneider Tel Aviv Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Christa E Flück
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics and Department of BioMedical Research, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Tulay Guran
- Marmara University, Department of Pediatric Endocrinology and Diabetes, Pendik, Istanbul, Turkey
| | - Fuat Bugrul
- Marmara University, Department of Pediatric Endocrinology and Diabetes, Pendik, Istanbul, Turkey
| | - Ayla Güven
- Saglik Bilimleri University Medical Faculty, Zeynep Kamil Women and Children Hospital, Pediatric Endocrinology Clinic, Istanbul, Turkey
| | - Violeta Iotova
- Department of Paediatrics, Medical University-Varna, UMHAT "Sv. Marina", Varna, Bulgaria
| | - Birgit Koehler
- Klinik für Pädiatrische Endokrinologie und Diabetologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jennyver-Tabea Schröder
- Klinik für Pädiatrische Endokrinologie und Diabetologie, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Daniel Konrad
- Division of Paediatric Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland
| | - Evelien Gevers
- Department of Paediatric Endocrinology, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University London, London, United Kingdom
| | - Ruth Krone
- Birmingham Women's & Children's Hospital, Department for Endocrinology & Diabetes, Birmingham, United Kingdom
| | - Tatjana Milenkovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Čupić", Belgrade, Serbia
| | - Ana Vieites
- Centro de Investigaciones Endocrinológicas, División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Richard Ross
- University of Sheffield, Sheffield, United Kingdom
| | | | - Ieuan Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Carlo Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Alexander Springer
- Department of Paediatric Surgery, Medical University Vienna, Vienna, Austria
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12
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Long CJ, Van Batavia J, Wisniewski AB, Aston CE, Baskin L, Cheng EY, Lakshmanan Y, Meyer T, Kropp B, Palmer B, Nokoff NJ, Paradis A, VanderBrink B, Scott Reyes KJ, Yerkes E, Poppas DP, Mullins LL, Kolon TF. Post-operative complications following masculinizing genitoplasty in moderate to severe genital atypia: results from a multicenter, observational prospective cohort study. J Pediatr Urol 2021; 17:379-386. [PMID: 33726972 PMCID: PMC8713352 DOI: 10.1016/j.jpurol.2021.02.006] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Differences of sex development (DSD) are congenital conditions in which there is atypical chromosomal, gonadal and/or phenotypic sex. A phenotype of severe genital atypia in patients raised as male is a relatively rare occurrence and standards for management are lacking. Decision making for early surgical planning in these rare cases includes, but is not limited to, degree of atypia, location of testes, and presence of Mϋllerian remnants. In this study we describe surgical approaches and short-term outcomes for masculinizing genitoplasty in moderate to severe genital atypia in young patients raised male, for whom parents opted for early surgery. METHODS This NIH-sponsored study is an ongoing, observational, multicenter investigation assessing medical, surgical and psychological outcomes in children and their parents affected by atypical genitalia due to DSD. Participants were prospectively enrolled from 12 children's hospitals across the United States that specialize in DSD care. Criteria for child enrollment were a Quigley score of 3-6 in those with a 46, XY or 45,X/46, XY chromosome complement, age <3 years with no previous genitoplasty; patients were included independent of whether genitoplasty was performed. Cosmesis was graded according to a 4-point Likert scale and complications per the Clavian-Dindo classification. RESULTS Of the 31 participants, 30 underwent hypospadias repair and 1 patient did not undergo a genitoplasty procedure. The majority of participants (22) received a staged hypospadias repair. Seventeen complications were identified in 12 of the 31 children (41%) at 12 months of follow up. Glans dehiscence and urethrocutaneous fistula were the most common complications. Orchiopexy was performed in 14 (44%) and streak gonads were removed in 4 (13%) participants. Both parents and surgeons reported improved cosmesis after surgery when compared to baseline. CONCLUSION Genitoplasty was chosen by parents for the majority of children eligible for study. No single surgical approach for masculinizing moderate to severe genital ambiguity in young patients with 46, XY or 45,X/46, XY DSD was adopted by all surgeons. Complications occurred in 41% of those who underwent genitoplasty for severe hypospadias. Overall, appearance of the genitals, as determined by parents and surgeons, improved following genitoplasty. Outcomes of early genitoplasty are needed to guide families when making decisions about such procedures for their young children.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dix P Poppas
- New York Presbyterian Hospital/Weill Cornell Medicine, USA.
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13
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Unal E, Demiral M, Yıldırım R, Taş FF, Ceylaner S, Özbek MN. Cytochrome P450 oxidoreductase deficiency caused by a novel mutation in the POR gene in two siblings: case report and literature review. Hormones (Athens) 2021; 20:293-298. [PMID: 33123976 DOI: 10.1007/s42000-020-00249-z] [Citation(s) in RCA: 6] [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: 05/06/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION P450 oxidoreductase (POR) deficiency is a rare form of congenital adrenal hyperplasia. In both genders, it can lead to ambiguous genitalia, impaired steroidogenesis, and skeletal findings similar to those of Antley-Bixler syndrome. CASES We describe two cases of POR deficiency. The first case was an 8.5-year-old girl who was admitted to our clinic due to ambiguous genitalia. Karyotype was 46, XX. There were mild dysmorphic facial findings and mild metacarpophalangeal joint deformity. The patient's basal cortisol and ACTH levels were normal, while 17-hydroxyprogesterone (17OHP) levels were high. Peak cortisol response to the ACTH stimulation test was found to be insufficient. Our second case, a sibling of the first case, was admitted for routine checkup at the age of 15 months. As in our first case, there were dysmorphic facial findings and metacarpophalangeal joint deformity. The genital structure was normal. Karyotype was 46, XY. Basal cortisol and ACTH levels were normal, while 17OHP level was slightly high. Peak cortisol response to the ACTH stimulation test was found to be insufficient. Based on our findings, POR deficiency was considered in both of these cases and NM_000941.3:c.929_937delTCTCGGACT(p.Ile310_Ser313delinsThr) (homozygous) mutation was detected in the POR gene that had not previously been described. CONCLUSION We detected a novel variant in the POR gene in two sibling cases with adrenal insufficiency, dysmorphic face, and mild skeletal findings. While the detected mutation caused ambiguous genitalia in the female case, it did not cause ambiguous genitalia in the male case.
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Affiliation(s)
- Edip Unal
- Department of Pediatric Endocrinology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey.
| | - Meliha Demiral
- Department of Pediatric Endocrinology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Ruken Yıldırım
- Department of Pediatric Endocrinology, Diyarbakır Children's Hospital, Diyarbakır, Turkey
| | - Funda Feryal Taş
- Department of Pediatric Endocrinology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Serdar Ceylaner
- Department of Medical Genetics, Intergen Genetic Diagnosis Center, Ankara, Turkey
| | - Mehmet Nuri Özbek
- Department of Pediatric Endocrinology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
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Tajouri A, Kharrat M, Trabelsi M, M'rad R, Hiort O, Werner R. In vitro functional characterization of androgen receptor gene mutations at arginine p.856 of the ligand-binding-domain associated with androgen insensitivity syndrome. J Steroid Biochem Mol Biol 2021; 208:105834. [PMID: 33548461 DOI: 10.1016/j.jsbmb.2021.105834] [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: 11/03/2020] [Revised: 01/12/2021] [Accepted: 01/29/2021] [Indexed: 11/22/2022]
Abstract
Androgens are critical for male sex differentiation. Their actions are mediated by the androgen receptor (AR). Mutations disrupting AR function result in the androgen insensitivity syndrome (AIS). In this study, we identified in a patient with complete AIS, a novel AR mutation p.R856L. To investigate the functional properties of p.R856L, we performed functional studies. In comparison, we have characterized two already described mutations: p.R856H and p.R856C. We used a model composed of two different promoters fused to a reporter gene, two cell lines, and showed that all mutations were able to transactivate the (ARE)2-TATA promoter expressed in CHO cells more highly. Moreover, we confirmed the pathogenicity of the p.R856L and p.R856C mutations, and their associations with complete AIS. In contrast, the p.R856H mutation, which is associated with a spectrum of AIS phenotypes, showed less severe transcriptional constraints. Altogether, our studies allowed us to better characterize arginine residue at p.R856 position.
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Affiliation(s)
- Asma Tajouri
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES10 Human Genetics Laboratory, 1007, Tunis, Tunisia; Department of Paediatric and Adolescent Medicine, Division of Paediatric Endocrinology and Diabetes, University of Luebeck, 23562, Luebeck, Germany
| | - Maher Kharrat
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES10 Human Genetics Laboratory, 1007, Tunis, Tunisia.
| | - Mediha Trabelsi
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES10 Human Genetics Laboratory, 1007, Tunis, Tunisia; Department of Congenital and Hereditary Diseases, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ridha M'rad
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES10 Human Genetics Laboratory, 1007, Tunis, Tunisia; Department of Congenital and Hereditary Diseases, Charles Nicolle Hospital, Tunis, Tunisia
| | - Olaf Hiort
- Department of Paediatric and Adolescent Medicine, Division of Paediatric Endocrinology and Diabetes, University of Luebeck, 23562, Luebeck, Germany
| | - Ralf Werner
- Department of Paediatric and Adolescent Medicine, Division of Paediatric Endocrinology and Diabetes, University of Luebeck, 23562, Luebeck, Germany; Institute of Molecular Medicine, University of Luebeck, 23562, Luebeck, Germany.
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15
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Costagliola G, Cosci O di Coscio M, Masini B, Baldinotti F, Caligo MA, Tyutyusheva N, Sessa MR, Peroni D, Bertelloni S. Disorders of sexual development with XY karyotype and female phenotype: clinical findings and genetic background in a cohort from a single centre. J Endocrinol Invest 2021; 44:145-151. [PMID: 32378143 DOI: 10.1007/s40618-020-01284-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [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: 03/23/2020] [Accepted: 04/28/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE 46, XY disorders (or differences) of sex development (DSD) are a group of clinical conditions with variable genetic background; correct diagnosis is often difficult, but it permits to optimize the management. The aim of this study is to identify clinical and genetics features of a group of women with 46, XY DSD to define some issues characterizing people with 46, XY DSD in Italy. METHODS Retrospective analysis of girls and women with 46, XY DSD and female phenotype evaluated between year 2000 and 2016, performed by anonymised database, focusing on the clinical features and management, including presentation, first diagnostic suspect, gonadal surgery and molecular diagnostic delay. RESULTS A total of 84 records were collected (mean age at clinical presentation: 9.1 ± 7.9 years; mean age at definitive diagnosis: 20.1 ± 15.0 years). Complete androgen insensitivity syndrome was the most common diagnosis (60%). Only 12 patients (14.3%) did not receive a molecular diagnosis. Early misdiagnoses frequently occurred; diagnostic delay was 10.2 ± 11.2 years, being reduced in patients presenting from 2007 to 2016. The discordance between genotypic and phenotypic sex during pregnancy or at birth determined early reason for referral in a considerable percentage (4.9%). CONCLUSION Misdiagnosis and long diagnostic delays are present in females with 46, XY DSD in Italy, but the new genetic techniques permit faster right diagnoses in the last years. The centralization in dedicated third level units permits to reduce the number of patients without a molecular diagnosis, allowing better clinical management and appropriate genetic counselling.
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Affiliation(s)
- G Costagliola
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Pediatric and Adolescent Endocrinology, University of Pisa, Pisa, Italy
| | - M Cosci O di Coscio
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Pediatric and Adolescent Endocrinology, University of Pisa, Pisa, Italy
| | - B Masini
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Pediatric and Adolescent Endocrinology, University of Pisa, Pisa, Italy
| | - F Baldinotti
- Laboratory of Molecular Genetics, Azienda Ospedaliero Universitaria Pisa, Pisa, Italy
| | - M A Caligo
- Laboratory of Molecular Genetics, Azienda Ospedaliero Universitaria Pisa, Pisa, Italy
| | - N Tyutyusheva
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Pediatric and Adolescent Endocrinology, University of Pisa, Pisa, Italy
| | - M R Sessa
- Laboratory of Endocrinology, Azienda Ospedaliero Universitaria Pisa, Pisa, Italy
| | - D Peroni
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Pediatric and Adolescent Endocrinology, University of Pisa, Pisa, Italy
| | - S Bertelloni
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Pediatric and Adolescent Endocrinology, University of Pisa, Pisa, Italy.
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Byers HM, Fossum M, Wu HY. How geneticists think about Differences/ Disorders of Sexual Development (DSD): A conversation. J Pediatr Urol 2020; 16:760-7. [PMID: 32893165 DOI: 10.1016/j.jpurol.2020.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 12/27/2022]
Abstract
A multidisciplinary DSD clinic offers the opportunity for different specialties to learn from each other, as each provides their own perspective and expertise to the management of these complex patients, leading to collaborative care. For the patient, a multi-disciplinary clinic can improve access to care and decrease stress, as patients see all of the specialists on one day. For urologists seeing patients with DSD within a multi-disciplinary DSD clinic as well as independently, understanding what other specialists provide can help facilitate care and referral. Medical genetics is part of a multi-disciplinary DSD clinic. Given the recent advances in genetic diagnostics, many of the offered tests may be less familiar to the pediatric urologist. Therefore, this conversation reviews the clinical presentations and genetic testing options including chromosomal microarray, genetic testing panel, whole exome sequencing, and whole genome sequencing and how these can be helpful in the diagnosis and management of patients with DSD conditions.
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17
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Jandou I, Mhanna T, Chennoufi M, Aynaou M, El Houmaidi A, Barki A. Hypofertility in a persistence of mullerian duct syndrome: Case report. Int J Surg Case Rep 2020; 77:778-781. [PMID: 33395894 PMCID: PMC7718311 DOI: 10.1016/j.ijscr.2020.11.011] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/01/2020] [Indexed: 11/15/2022] Open
Abstract
PMDS is a rare, autosomal recessive sexual development abnormality characterized by the coexistence of Mullerian derivatives in a male phenotype and genotype patient. Can be identified during the surgery of cryptorchidism, and more rarely by an ectopic testicular degeneration. The PMDS has a good prognosis despite the increased risk of infertility as well as testicular and Mullerian degeneration. The treatment requires a multidisciplinary approach.
Introduction Persistent Mullerian duct syndrome is a rare form of pseudohermaphroditism, possibly resulting from the absence of Mullerian duct inhibiting factor. Presentation of case We report the case of a 36 year-old patient with a syndrome of persistent Müllerian ducts (PMDS) of the female type. The Clinical examination revealed avacant scrotum, a normal penis. The spermogram analysis found azoospermia. Imaging using ultrasound and tomotensidometry found the presence of amass in the back of bladder. A Laparoscopic exploration revealed two slightly enlarged testicles, in a pelvic situation intimately confined to a rudimentary uterus with two tubes. The histological examination was in favor of a uterine endometrium and two fallopian tubes. The karyotype requested later was male 46 XY. Discussion Since the first case, between 200 and 262 cases have been reported in literature around the world, this might reveal that the incidence and prevalence of this type of diseases are not well-estimated. The diagnosis is often a fortuitous discovery during a cryptorchidism surgery or inguinal hernia, more rarely during the management of a state of infertility or the degenerescence of the testis or Mullerian derivative. It is caused by either the anti-Mullerian hormone deficiency (AMH) or a dysfunction of its receptor. Conclusion A multidisciplinary approach is necessary for surgical management. long-term prognosis is favorable, though fertility seem to be decreased and also it might lead to a riskiness of malignancy owing to cryptorchidism and preserved Mullerian remants.
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Affiliation(s)
- Issam Jandou
- University Hospital Center Ibn Rochd, Casablanca, Morocco; Faculty of Medicine of Casablanca, Morocco.
| | - Tarik Mhanna
- Mohamed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohamed Ist University, Oujda, Morocco
| | - Mehdi Chennoufi
- Mohamed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohamed Ist University, Oujda, Morocco
| | - Mohamed Aynaou
- Mohamed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohamed Ist University, Oujda, Morocco
| | - Amine El Houmaidi
- Mohamed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohamed Ist University, Oujda, Morocco
| | - Ali Barki
- Mohamed VI University Hospital, Oujda, Morocco; Faculty of Medicine and Pharmacy, Mohamed Ist University, Oujda, Morocco
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18
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AbouZeid AA, Mohammad SA. Transformation of the female genitalia in congenital adrenal hyperplasia: MRI study. J Pediatr Surg 2020; 55:977-984. [PMID: 32037221 DOI: 10.1016/j.jpedsurg.2020.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/06/2019] [Revised: 12/11/2019] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE In this report, we aim to define the different degrees of structural abnormality affecting the female genitalia in cases of CAH by using the multiplanar capabilities and high soft tissue resolution of MRI. PATIENTS AND METHODS The study included cases of CAH who were referred to our pediatric surgical facility for genital reconstruction during the period 2016 through 2019. We studied the pelvic MRI anatomy in cases of CAH while referring to clinical and operative findings. To set up a grading scale for the degree of virilization in cases of CAH, we included another two control groups of normal boys and girls representing the two ends of the spectrum. RESULTS The study included 23 cases of CAH who underwent preoperative pelvic MRI examination. All cases had normal chromosomal analysis (46 XX). Their age ranged from 1 to 156 months at time of MRI examination (mean 42.4; median 25). The level of the lower end of the vagina was identified in midsagittal T2WI and confirmed in sequential axial cuts. Based on the level of the lower end of the vagina in relation to the pubic symphysis, we classified cases of CAH into either low or high types. Moreover, we could observe a correlation between the degree of vaginal descent and structural transformation of erectile tissue between both genders. CONCLUSION MRI can have an important role in the evaluation of cases of CAH by displaying the severity of internal anomaly which is crucial for proper preoperative counseling. TYPE OF STUDY Case control study. LEVEL OF EVIDENCE Level III.
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Abstract
Congenital adrenal hyperplasia (CAH) due to steroid 21-hydroxylase deficiency (21OHD) has a worldwide incidence of 1 in 15-20,000. Affected individuals have adrenal insufficiency and androgen excess; the androgen excess begins during fetal life, typically resulting in 46,XX disordered sexual development. In 21OHD, 17-hydroxyprogesterone (17OHP), the steroid proximal to 21-hydroxylase, accumulates. Most industrialized countries have newborn screening programs that measure 17OHP; such screening has permitted rapid detection of newborns with 21OHD, saving lives previously lost to mineralocorticoid deficiency and salt wasting. However, newborn screening is plagued by false positives. 17OHP is above most "cutoff values" in the first 24 h of life, is high in otherwise normal premature infants, and in many term infants with physiologic stress from unrelated diseases. In addition, newborn 17OHP may be elevated in other forms of CAH, including 11-hydroxylase deficiency, 3β-hydroxysteroid dehydrogenase deficiency, and P450 oxidoreductase deficiency. In 21OHD, some of the accumulated intra-adrenal 17OHP is converted to 21-deoxycortisol (21-deoxy) by 11β-hydroxylase (CYP11B1); 21-deoxy is not elevated in premature infants or in other forms of CAH, and hence is a more specific marker for 21OHD. However, 21-deoxy assays have not been generally available until recently, hence experience is limited. We urge clinical investigators, commercial reference laboratories, and newborn screening programs to investigate replacing 17OHP with 21-deoxy as the analyte of choice for studies of 21OHD.
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Affiliation(s)
- Walter L Miller
- Department of Pediatrics and Center for Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA,
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20
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García-Acero M, Moreno O, Suárez F, Rojas A. Disorders of Sexual Development: Current Status and Progress in the Diagnostic Approach. Curr Urol 2020; 13:169-178. [PMID: 31998049 DOI: 10.1159/000499274] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/14/2018] [Indexed: 12/13/2022] Open
Abstract
Disorders of sexual development (DSD) are conditions with an atypical chromosomal, gonadal or phenotypic sex, which leads to differences in the development of the urogenital tract and different clinical phenotypes. Some genes have been implicated in the sex development during gonadal and functional differentiation where the maintenance of the somatic sex of the gonad as either male or female is achieved by suppression of the alternate route. The diagnosis of DSD requires a structured approach, involving a multidisciplinary team and different molecular techniques. We discuss the dimorphic genes and the specific pathways involved in gonadal differentiation, as well as new techniques for genetic analysis and their diagnostic value including epigenetic mechanisms, expanding the evidence in the diagnostic approach of individuals with DSD to increase knowledge of the etiology.
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Affiliation(s)
- Mary García-Acero
- Human Genetic Institute, Medicine Faculty, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Olga Moreno
- Human Genetic Institute, Medicine Faculty, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Fernando Suárez
- Human Genetic Institute, Medicine Faculty, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Adriana Rojas
- Human Genetic Institute, Medicine Faculty, Pontificia Universidad Javeriana, Bogotá, Colombia
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Chow JS, Paltiel HJ, Padua HM, McNamara E, Dickie BH. Case series: Comparison of contrast-enhanced genitosonography (ceGS) to fluoroscopy and cone-beam computed tomography in patients with urogenital sinus and the cloacal malformation. Clin Imaging 2019; 60:204-208. [PMID: 31927495 DOI: 10.1016/j.clinimag.2019.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/15/2019] [Accepted: 11/21/2019] [Indexed: 11/26/2022]
Abstract
In this case series, contrast enhanced genitosonography is compared to genitography performed using fluoroscopy and cone-beam computed tomography in patients with urogenital sinus and the cloacal malformation. The method of contrast enhanced genitosonography is described, including contrast preparation, contrast administration, ultrasound imaging approaches, as well as the benefits and potential pitfalls of this technique compared to fluoroscopy and computed tomography.
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Affiliation(s)
- Jeanne S Chow
- Boston Children's Hospital, 300 Longwood Avenue, Department of Radiology, Boston, MA 02115, United States of America.
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Ferong K, Waterschoot M, Sinatti C, Van Laecke E, Cools M, Hoebeke P, Spinoit AF. Rare and special robotic surgery indications in the pediatric population: ectopic organs and differences of sexual development. World J Urol 2019; 38:1865-1868. [PMID: 31440805 DOI: 10.1007/s00345-019-02913-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 08/14/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Differences of sexual development (DSD) affect the development of internal reproductive organs and external genitalia. Ectopic kidney is a rare and challenging pathology causing amongst others incontinence and recurrent urinary tract infections. Those pathologies may in certain cases be an indication for surgery. This manuscript aims to evaluate the role of robot-assisted laparoscopy in the surgical treatment of patients with ectopic kidneys or DSD. MATERIALS AND METHODS A prospective database is maintained in a tertiary referral center with all robotic surgeries performed in children. From this database, a prospective series of robot-assisted resection of embryologic remnants located in the pelvis was extracted: resection of a prostatic utricle cyst, removal of ectopic non-functional kidneys, and resection of a hemi-uterus. RESULTS From an initial database including 72 patients, six patients met the inclusion criteria. Three male patients presenting with utricle cysts, two young girls presenting with ectopic kidneys, and one young boy with pelvic embryological remnants of the uterus, were further evaluated. CONCLUSION Surgical treatment of patients with DSD is safe, feasible, and a good indication for robot-assisted laparoscopic surgery, as both deep dissection and reconstruction in a limited surgical field are requested.
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Affiliation(s)
- Kristel Ferong
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Céline Sinatti
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Erik Van Laecke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Martine Cools
- Department of Pediatric Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Piet Hoebeke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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Nishi K, Inoguchi T, Kamei K, Hamada R, Hataya H, Ogura M, Sato M, Yoshioka T, Ogata K, Ito S, Nakanishi K, Nozu K, Hamasaki Y, Ishikura K. Detailed clinical manifestations at onset and prognosis of neonatal-onset Denys-Drash syndrome and congenital nephrotic syndrome of the Finnish type. Clin Exp Nephrol 2019; 23:1058-65. [PMID: 30963316 DOI: 10.1007/s10157-019-01732-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Neonatal-onset Denys-Drash syndrome (NODDS) is a distinctive clinical entity and has a poor renal and life outcome. Early diagnosis of NODDS is important for managing disorders of sexual development and determining assigned gender. Although patients with NODDS and congenital nephrotic syndrome of the Finnish type (CNF) present with nephrotic syndrome in neonatal life or infancy, the clinical course of NODDS and factors distinguishing these diseases at onset is unknown. METHODS We performed a retrospective cohort study of patients with NODDS and CNF between 1997 and 2017. Patients with nephrotic syndrome and WT1 or NPHS1 mutations with neonatal onset (within 30 days) were eligible. RESULTS We studied eight patients with NODDS and 15 with CNF. The median serum creatinine level at onset in the NODDS group was significantly higher (1.85 mg/dL) than that in the CNF group (0.15 mg/dL; P = 0.002). The median placental/fetal weight ratio in the NODDS and CNF group was 41.8% and 21.0%, respectively (P = 0.001). Kaplan-Meier analysis showed that the median number of days for progression to ESRD from onset in the NODDS and CNF groups was 6 and 910 days, respectively (P < 0.001). All patients in the NODDS group were alive at follow-up. Only one patient in the CNF group died of cardiac complications during follow-up. CONCLUSION CNS, renal dysfunction at onset, and a relatively large placenta are prominent signs of NODDS. Prognosis for patients with NODDS is satisfactory if appropriate and active management is performed.
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Hertweck SP, Rothstein DH. Challenges and Opportunities in Adolescent Gynecology Patients with Surgically-Treated Congenital and Acquired Anomalies: Transition of Care from Pediatric to Adult Surgery. J Pediatr Adolesc Gynecol 2019; 32:103-109. [PMID: 30529499 DOI: 10.1016/j.jpag.2018.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 11/06/2018] [Accepted: 11/12/2018] [Indexed: 12/17/2022]
Abstract
The transition from adolescence to young adulthood in patients with reproductive health care needs such as disorders of sexual development and congenital anomalies is a complex process that occurs over several years. The transition process for these patients is still poorly understood. The patients with disorders of sexual development and reproductive issues have specific and unique issues regarding timing of disclosure of diagnosis, genital examinations, gonadectomy, vaginal treatments, surgical procedures, hormone replacement therapy, use of long-term medication, and potential cancer screening. The purpose of this review is to briefly describe complex genital malformations and their associated anomalies with long-term concerns and then provide an overview of what has been published at this time regarding the transition of care to provide some guidance for providers who care for those patients.
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Affiliation(s)
- S Paige Hertweck
- Norton Children's Hospital, University of Louisville, Louisville, KY.
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Abd Wahab AV, Lim LM, Mohamed Tarmizi MH. Ovotesticular Disorders of Sex Development: Improvement in Spermatogonia after Removal of Ovary and Müllerian Structures. J Pediatr Adolesc Gynecol 2019; 32:74-77. [PMID: 30248506 DOI: 10.1016/j.jpag.2018.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/11/2018] [Accepted: 09/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Ovotesticular disorders of sex development is a condition defined as the presence of ovarian tissue containing ovarian follicles and testicular tissue containing seminiferous tubules in the same individual. CASE We report on a 19-year-old who is phenotypically male, with a 46,XX/46,XY mosaicism karyotype, who presented later in life with cyclical abdominal pain that resembled menstrual cramps and unilateral undescended testes. SUMMARY AND CONCLUSION He underwent laparoscopic hysterectomy and right salpingo-oophorectomy, resulting in cessation of his symptoms and improved sperm count.
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Affiliation(s)
- Ana Vetriana Abd Wahab
- Department of Obstetrics and Gynaecology, Sabah Women's and Children's Hospital, Kota Kinabalu, Sabah, Malaysia.
| | - Leek Mei Lim
- Department of Obstetrics and Gynaecology, Sabah Women's and Children's Hospital, Kota Kinabalu, Sabah, Malaysia
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Nasir AA, Abdur-Rahman LO, Adesiyun OO, Bamigbola KT, Adegboye MB, Raji HO, Adesiyun OAM, Adeniran JO. Analysis of Presentations and Outcomes of Care of Children with Disorders of Sexual Development in a Nigerian Hospital. J Pediatr Adolesc Gynecol 2019; 32:21-26. [PMID: 30149125 DOI: 10.1016/j.jpag.2018.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/13/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022]
Abstract
STUDY OBJECTIVE To describe the presentation, diagnosis, management, and short-term outcome of children with disorders of sexual development (DSD) in the context of multidisciplinary team care. DESIGN Prospective descriptive study. SETTING University Teaching Hospital. PARTICIPANTS All children who presented with genital ambiguity. INTERVENTIONS AND MAIN OUTCOME MEASURES Records of all patients diagnosed and managed for DSD between January 2011 and December 2016 were reviewed. The care pathway included clinical, laboratory, internal genitalia evaluation, and panel (including parents) meeting. RESULTS Fifteen children presented with DSD at a median age of 20 months. Only 5/15 (33.3%) presented in the neonatal period. Ten of fifteen patients (66.7%) presented with genital ambiguity. Ovotesticular DSD was the most common diagnosis (9/15; 60%). Seven of the patients were genetically female (46, XX), 1 was genetically male (46, XY) and 1 without genetic diagnosis. Six patients were assigned male gender and they underwent male genitoplasty. Five of them had excision of Müllerian structures with gonadectomy. Three of fifteen patients (20%) were diagnosed as 46, XX DSD, at a median age of 7 years. All of them were due to congenital adrenal hyperplasia and underwent female genitoplasty. Two patients were diagnosed as XY, DSD. They were both raised as female at presentation and were reassigned male sex. Both had urethroplasty done. Four patients had postoperative urethrocutaneous fistula and 1 had partial wound dehiscence. The median follow-up period was 21 months (interquartile range, 2-26 months). CONCLUSION The frequency of ovotesticular DSD is high in our setting. The decision of sex assignment was finally made at a median age of 7.5 months in most of our patients with satisfactory short-term surgical outcome.
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Affiliation(s)
- Abdulrasheed A Nasir
- Division of Paediatric Surgery, Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria.
| | - Lukman O Abdur-Rahman
- Division of Paediatric Surgery, Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Omotayo O Adesiyun
- Department of Paediatrics, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Kayode T Bamigbola
- Division of Paediatric Surgery, Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Majeed B Adegboye
- Department of Anaesthesia, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Hadijat O Raji
- Department of Obstetrics and Gynaecology, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Olusola A M Adesiyun
- Department of Radiology, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - James O Adeniran
- Division of Paediatric Surgery, Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Abstract
The field of transitional urology has taken on an increasing importance in recent years as more individuals with congenital urologic issues are living and thriving into adulthood. This article reviews the transitional process itself including barriers to successful transition and the consequences of failing to properly transition. Also provided is a broad overview of the urologic issues faced by patients who may benefit from lifelong care and the providers who will be helping them with transition and assuming their care.
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Affiliation(s)
- Robert C Kovell
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Children's Hospital of Philadelphia, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, 3 West, Philadelphia, PA 19104, USA.
| | - Alexander J Skokan
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, 3 West, Philadelphia, PA 19104, USA
| | - Dan N Wood
- Department of Urology, University College London Hospitals, 16-18 Westmoreland Street, London W1H 6PL, UK
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Ilaslan E, Calvel P, Nowak D, Szarras-Czapnik M, Slowikowska-Hilczer J, Spik A, Sararols P, Nef S, Jaruzelska J, Kusz-Zamelczyk K. A Case of Two Sisters Suffering from 46,XY Gonadal Dysgenesis and Carrying a Mutation of a Novel Candidate Sex-Determining Gene STARD8 on the X Chromosome. Sex Dev 2018; 12:191-195. [PMID: 29886504 DOI: 10.1159/000489692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2018] [Indexed: 11/19/2022] Open
Abstract
Identification of novel genes involved in sexual development is crucial for understanding disorders of sex development (DSD). Here, we propose a member of the START domain family, the X chromosome STARD8, as a DSD candidate gene. We have identified a missense mutation of this gene in 2 sisters with 46,XY gonadal dysgenesis, inherited from their heterozygous mother. Gonadal tissue of one of the sisters contained Leydig cells overloaded with cholesterol droplets, i.e., structures previously identified in 46,XY DSD patients carrying mutations in the STAR gene encoding another START domain family member, which is crucial for steroidogenesis. Based on the phenotypes of our patients, we propose a dual role of STARD8 in sexual development, namely in testes determination and testosterone synthesis. However, further studies are needed to confirm the involvement of STARD8 in sexual development.
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Baker LL. Gender by Dasein? A Heideggerian critique of Suzanne Kessler and the medical management of infants born with disorders of sexual development. Theor Med Bioeth 2017; 38:447-463. [PMID: 28948447 DOI: 10.1007/s11017-017-9424-x] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article explores the relationship between gender, technology, language, and how infants and children born with disorders of sexual development are shaped into intelligible members of the community. The contemporary medical model maintains that children ought to be both socially and surgically assigned and reared as one particular gender. Gender scholar Suzanne Kessler rejects this position and argues for the acceptance of greater genital variability through the use of language. Using a Heideggerian lens, the main question I seek to answer in this article is: does Kessler's approach succeed in its aim to better treat individuals born with disorders of sexual development? I argue that Kessler is successful in offering practical solutions for persons with intersexed conditions to exist and flourish as intelligible members of the community, but that her project ultimately relies on power to "challenge forth" greater acceptance of genital variance. Building on the work of Kessler and Heidegger, I argue that a better approach to making intelligible the existence of an infant born with a disorder of sexual development is not to rely on the manipulation of language, but to instead reinvigorate a sense of the sacred in response to having an intersex condition.
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Affiliation(s)
- Lauren L Baker
- Albert Gnaegi Center for Health Care Ethics, Saint Louis University, 3545 Lafayette Ave, Suite 510, St. Louis, MO, 63104-1314, USA.
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Batista RL, Rodrigues ADS, Nishi MY, Gomes NL, Faria JAD, Moraes DRD, Carvalho LR, Costa EMF, Domenice S, Mendonca BB. A recurrent synonymous mutation in the human androgen receptor gene causing complete androgen insensitivity syndrome. J Steroid Biochem Mol Biol 2017; 174:14-16. [PMID: 28743543 DOI: 10.1016/j.jsbmb.2017.07.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 05/30/2017] [Accepted: 07/18/2017] [Indexed: 12/14/2022]
Abstract
Androgen insensitivity syndrome (AIS) is the most common cause of 46,XY disorders of sex development (46,XY DSD). This syndrome is an X-linked inheritance disease and it is caused by mutations in the human androgen receptor (AR) gene. Non-synonymous point AR mutations are frequently described in this disease, including in the complete phenotype. We present a novel synonymous mutation in the human AR gene (c.1530C > T) in four 46,XY patients from two unrelated families associated with complete androgen insensitivity syndrome (CAIS). The analysis of mRNA from testis showed that synonymous AR mutation changed the natural exon 1 donor splice site, with deletion of the last 92 nucleotides of the AR exon 1 leading to a premature stop codon 12 positions ahead resulting in a truncate AR protein. Linkage analyses suggested a probable founder effect for this mutation. In conclusion, we described the first synonymous AR mutation associated with CAIS phenotype, reinforcing the disease-causing role of synonymous mutations.
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Affiliation(s)
- Rafael Loch Batista
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Andresa di Santi Rodrigues
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Mirian Yumie Nishi
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Nathalia Lisboa Gomes
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Antonio Diniz Faria
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Daniela Rodrigues de Moraes
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luciani Renata Carvalho
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Elaine Maria Frade Costa
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Sorahia Domenice
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Berenice Bilharinho Mendonca
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Auger-Hunault M, Lardy H, Braïk K, Alzahrani K, Crenn R, Magontier N, Mure PY, Binet A. Robotic-assisted laparoscopy vaginal pull-through: A new surgical approach in pediatric surgery. Prog Urol 2017; 27:600-601. [PMID: 28822741 DOI: 10.1016/j.purol.2017.07.236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 10/19/2022]
Affiliation(s)
- M Auger-Hunault
- Service de chirurgie pédiatrique viscérale, urologique et plastique, hôpital Gatien-de-Clocheville, CHRU de Tours, 49, boulevard Beranger, 37044 Tours cedex, France
| | - H Lardy
- Service de chirurgie pédiatrique viscérale, urologique et plastique, hôpital Gatien-de-Clocheville, CHRU de Tours, 49, boulevard Beranger, 37044 Tours cedex, France
| | - K Braïk
- Service de chirurgie pédiatrique viscérale, urologique et plastique, hôpital Gatien-de-Clocheville, CHRU de Tours, 49, boulevard Beranger, 37044 Tours cedex, France
| | - K Alzahrani
- Service de chirurgie pédiatrique viscérale, urologique et plastique, hôpital Gatien-de-Clocheville, CHRU de Tours, 49, boulevard Beranger, 37044 Tours cedex, France
| | - R Crenn
- Service d'anesthésie réanimation, hôpital Gatien-de-Clocheville, CHRU de Tours, 37000 Tours, France
| | - N Magontier
- Service de médecine pédiatrique, hôpital Gatien-de-Clocheville, CHRU de Tours, 37000 Tours, France
| | - P Y Mure
- Service de chirurgie uro-génitale, viscérale, thoracique, néonatale et transplantation, hôpital Femme-Mère-Enfant, CHRU de Lyon, 69677 Bron, France
| | - A Binet
- Service de chirurgie pédiatrique viscérale, urologique et plastique, hôpital Gatien-de-Clocheville, CHRU de Tours, 49, boulevard Beranger, 37044 Tours cedex, France.
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Mooij CF, van Herwaarden AE, Claahsen-van der Grinten HL. Disorders of Adrenal Steroidogenesis: Impact on Gonadal Function and Sex Development. Pediatr Endocrinol Rev 2017; 14:109-128. [PMID: 28508605 DOI: 10.17458/per.2016.mec.disordersofadrenal] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A defect in adrenal steroidogenesis may cause a disorder of sex development (DSD). Importantly, DSD of adrenal origin is not restricted to a genital phenotype but is in most cases accompanied by mild to severe impairment in glucocorticoid and/or mineralocorticoid synthesis. If a patient is suspected of DSD of adrenal origin evaluation of glucocorticoid and mineralocorticoid metabolism is therefore essential to provide adequate medical care in the case of a severe and potentially life-threatening insufficiency. The adrenal steroidogenic defects causing DSD, their clinical features and diagnostic work-up are discussed. In this review we provide an overview of defects in the adrenal steroidogenesis and its impact on gonadal function and sex development.
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Affiliation(s)
- Christiaan F Mooij
- Department of Pediatric Endocrinology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Hedi L Claahsen-van der Grinten
- Department of Pediatric Endocrinology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
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Arcila-Ruiz MJ, Assimos DG, Brucker BM, Chancellor MB, Druskin SC, Curtis Nickel J, Partin AW, Shapiro E. Best of the 2017 AUA Annual Meeting: Highlights From the 2017 American Urological Association Annual Meeting, May 12-16, 2017, Boston, MA. Rev Urol 2017; 19:169-179. [PMID: 29302240 PMCID: PMC5737344 DOI: 10.3909/riu0763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Dean G Assimos
- University of Alabama at Birmingham School of MedicineBirmingham, AL
| | | | | | - Sasha C Druskin
- The James Buchanan Brady Urological Institute at the Johns Hopkins Medical InstitutionsBaltimore, MD
| | | | - Alan W Partin
- The James Buchanan Brady Urological Institute at the Johns Hopkins Medical InstitutionsBaltimore, MD
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34
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Khorashad BS, Roshan GM, Reid AG, Aghili Z, Hiradfar M, Afkhamizadeh M, Talaei A, Aarabi A, Ghaemi N, Taghehchian N, Saberi H, Farahi N, Abbaszadegan MR. Sexual orientation and medical history among Iranian people with Complete Androgen Insensitivity Syndrome and Congenital Adrenal Hyperplasia. J Psychosom Res 2017; 92:55-62. [PMID: 27998513 DOI: 10.1016/j.jpsychores.2016.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 11/30/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To report sexual orientation, relationship status and medical history of Iranian people with Differences of Sex Development (DSD) who were raised female. METHODS Our participants consisted of nineteen 46,XY individuals with Complete Androgen Insensitivity Syndrome (CAIS) and eighteen 46,XX individuals with Congenital Adrenal Hyperplasia (CAH) who were raised as females and older than 13years. As well as their relationship status and detailed medical history, an expert psychiatrist assessed their sexual orientation by a semi-structured psychiatric interview with them and, where applicable, their parents. RESULTS Five percent of CAH participants and 42% of CAIS participants were in a relationship, which was significantly different. All CAH individuals had been diagnosed at birth; 89% of CAIS had been diagnosed after puberty and due to primary amenorrhea and 11% were diagnosed in childhood due to inguinal hernia. Genital reconstructive surgery had been performed in 100% of CAH participants and 37% of CAIS. Regarding sexual contact experiences and sexual fantasies (androphilic, gynephilic or both), no significant differences were found. However, CAH females had significantly more gynephilic dreams (P=0.045). CONCLUSION This study, notable as one of the rare from a non-western culture, described sexual, medical and socioeconomic status of 46,XX CAH and 46,XY CAIS individuals living in Iran. Although broadly in line with previous findings from Western cultures, Iranian CAH individuals had fewer romantic relationships, but in contrast to previous studies their sexual orientation was only different from CAIS in the contents of sexual dreams.
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Affiliation(s)
- Behzad S Khorashad
- Transgender Studies Center, Mashhad University of Medical Sciences, Mashhad, Iran; Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ghasem M Roshan
- Transgender Studies Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Alistair G Reid
- Molecular Pathology Unit, Liverpool Clinical Laboratories, Liverpool, UK.
| | - Zahra Aghili
- Transgender Studies Center, Mashhad University of Medical Sciences, Mashhad, Iran; Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mehran Hiradfar
- Department of Pediatric Surgery, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mozhgan Afkhamizadeh
- Endocrine Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ali Talaei
- Transgender Studies Center, Mashhad University of Medical Sciences, Mashhad, Iran; Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Azadeh Aarabi
- Division of Human Genetics, Immunology Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Nosrat Ghaemi
- Department of Pediatrics, School of Medicine, Mashhad University of Medical sciences, Mashhad, Iran.
| | - Negin Taghehchian
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran.
| | - Hedieh Saberi
- Transgender Studies Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Nazanin Farahi
- Transgender Studies Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mohammad Reza Abbaszadegan
- Division of Human Genetics, Immunology Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
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Burkhard FZ, Parween S, Udhane SS, Flück CE, Pandey AV. P450 Oxidoreductase deficiency: Analysis of mutations and polymorphisms. J Steroid Biochem Mol Biol 2017; 165:38-50. [PMID: 27068427 DOI: 10.1016/j.jsbmb.2016.04.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [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: 03/18/2016] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 10/22/2022]
Abstract
Cytochrome P450 oxidoreductase (POR) is required for metabolic reactions of steroid and drug metabolizing cytochrome P450 proteins located in endoplasmic reticulum. Mutations in POR cause a complex set of disorders resembling combined deficiencies of multiple steroid metabolizing enzymes. The P450 oxidoreductase deficiency (PORD) was first reported in patients with symptoms of defects in steroidogenic cytochrome P450 enzymes and ambiguous genitalia, and bone malformation features resembling Antley-Bixler syndrome. POR is now classified as a separate and rare form of congenital adrenal hyperplasia (CAH), which may cause disorder of sexual development (DSD). Since the initial description of PORD in 2004, a large number of POR mutations and polymorphisms have been described. In this report we have performed computational analysis of mutations and polymorphisms in POR linked to metabolism of steroids and xenobiotics and pathology of PORD from the reported cases. The mutations in POR that were identified in patients with disruption of steroidogenesis also have severe effects on cytochrome P450 proteins involved in metabolism of drugs. Different variations in POR show a range of diverse effects on different partner proteins that are often linked to the location of the particular variants. The variations in POR that cause defective binding of co-factors always have damaging effects on all partner proteins, while the mutations causing subtle structural changes may lead to altered interaction with partner proteins and the overall effect may be different for each individual partner. Computational analysis of available sequencing data and mutation analysis shows that Japanese (R457H), Caucasian (A287P) and Turkish (399-401) populations can be linked to unique founder mutations. Other mutations identified so far were identified as rare alleles or in single isolated reports. The common polymorphism of POR is the variant A503V which can be found in about 27% of alleles in general population but there are remarkable differences among different sub populations.
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Affiliation(s)
- Fabian Z Burkhard
- Division of Pediatric Endocrinology, Department of Pediatrics, University Children's Hospital Bern, and Department of Clinical Research, University of Bern, Switzerland
| | - Shaheena Parween
- Division of Pediatric Endocrinology, Department of Pediatrics, University Children's Hospital Bern, and Department of Clinical Research, University of Bern, Switzerland
| | - Sameer S Udhane
- Division of Pediatric Endocrinology, Department of Pediatrics, University Children's Hospital Bern, and Department of Clinical Research, University of Bern, Switzerland
| | - Christa E Flück
- Division of Pediatric Endocrinology, Department of Pediatrics, University Children's Hospital Bern, and Department of Clinical Research, University of Bern, Switzerland
| | - Amit V Pandey
- Division of Pediatric Endocrinology, Department of Pediatrics, University Children's Hospital Bern, and Department of Clinical Research, University of Bern, Switzerland.
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Khattab A, Yau M, Qamar A, Gangishetti P, Barhen A, Al-Malki S, Mistry H, Anthony W, Toralles MB, New MI. Long term outcomes in 46, XX adult patients with congenital adrenal hyperplasia reared as males. J Steroid Biochem Mol Biol 2017; 165:12-17. [PMID: 27125449 DOI: 10.1016/j.jsbmb.2016.03.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 11/17/2015] [Revised: 02/12/2016] [Accepted: 03/28/2016] [Indexed: 01/11/2023]
Abstract
Patients with Congenital Adrenal Hyperplasia (CAH) owing to 21-hydroxylase deficiency and whose karyotype is 46, XX are usually assigned to the female gender. Reported herein are the long term outcomes in three patients with CAH whose karyotype is 46, XX and who were reared as males. A retrospective review of three CAH patients with a 46, XX karyotype who were reared as males was conducted. Gender assignment, clinical and biochemical data, pre and post-genitoplasty genital examinations were reviewed. Gender identity was tested by an extensive questionnaire. Gender role, sexual preference, marital status and sexual satisfaction were evaluated by interview. The three patients were genotyped for the CYP21A2 gene confirming the diagnosis of CAH. Owing to genital virilization, cultural preferences for male gender and the lack of newborn screening programs the three patients reported herein were assigned to the male gender at birth before the diagnosis of CAH was established. In adulthood the patients remained significantly virilized. Thorough psychosexual assessments in adulthood revealed well established male gender identities compatible with their male gender assignments at birth. In all three patients, gender role and behavior were consistent with male gender identity including sexual intercourse with female partners. The three patients reported herein revealed that male gender assignment to CAH patients with a 46, XX karyotype may have a successful outcome providing there is strong parental support and expert endocrine care. No standard guidelines have been published for the gender assignment of CAH patients with a 46, XX karyotype and genital ambiguity. More studies concerning gender assignment in CAH patients with a 46, XX karyotype reared as males are needed.
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Affiliation(s)
- A Khattab
- Division of Adrenal Steroid Disorders, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - M Yau
- Division of Adrenal Steroid Disorders, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - A Qamar
- Division of Adrenal Steroid Disorders, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - P Gangishetti
- Division of Adrenal Steroid Disorders, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - A Barhen
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - S Al-Malki
- Division of Adrenal Steroid Disorders, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - H Mistry
- Division of Adrenal Steroid Disorders, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - W Anthony
- Division of Adrenal Steroid Disorders, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - M B Toralles
- Genetica Medica, Universidade Federal da Bahia, Salvador, State of Bahia, Brazil
| | - Maria I New
- Division of Adrenal Steroid Disorders, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
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De Sousa SMC, Kassahn KS, McIntyre LC, Chong CE, Scott HS, Torpy DJ. Case report of whole genome sequencing in the XY female: identification of a novel SRY mutation and revision of a misdiagnosis of androgen insensitivity syndrome. BMC Endocr Disord 2016; 16:58. [PMID: 27821113 PMCID: PMC5100246 DOI: 10.1186/s12902-016-0141-7] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 10/21/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The 46,XY female is characterised by a male karyotype and female phenotype arising due to any interruption in the sexual development pathways in utero. The cause is usually genetic and various genes are implicated. CASE PRESENTATION Herein we describe a 46,XY woman who was first diagnosed with androgen insensitivity syndrome (testicular feminisation) at 18 years; however, this was later questioned due to the presence of intact Müllerian structures. The clinical phenotype suggested several susceptibility genes including SRY, DHH, NR5A1, NR0B1, AR, AMH, and AMHR2. To study candidate genes simultaneously, we performed whole genome sequencing. This revealed a novel and likely pathogenic missense variant (p.Arg130Pro, c.389G>C) in SRY, one of the major genes implicated in complete gonadal dysgenesis, hence securing this condition over androgen insensitivity syndrome as the cause of the patient's disorder of sexual development. CONCLUSION This case highlights the emerging clinical utility of whole genome sequencing as a tool in differentiating disorders of sexual development.
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Affiliation(s)
- Sunita M. C. De Sousa
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA Australia
- Department of Genetics and Molecular Pathology, Centre for Cancer Biology, an SA Pathology and UniSA alliance, Adelaide, SA Australia
- School of Medicine, University of Adelaide, Adelaide, SA Australia
- Hormones and Cancer Group, Garvan Institute of Medical Research, Sydney, NSW Australia
| | - Karin S. Kassahn
- Department of Genetics and Molecular Pathology, Centre for Cancer Biology, an SA Pathology and UniSA alliance, Adelaide, SA Australia
- School of Biological Sciences, University of Adelaide, Adelaide, SA Australia
| | - Liam C. McIntyre
- Department of Genetics and Molecular Pathology, Centre for Cancer Biology, an SA Pathology and UniSA alliance, Adelaide, SA Australia
| | - Chan-Eng Chong
- Department of Genetics and Molecular Pathology, Centre for Cancer Biology, an SA Pathology and UniSA alliance, Adelaide, SA Australia
| | - Hamish S. Scott
- Department of Genetics and Molecular Pathology, Centre for Cancer Biology, an SA Pathology and UniSA alliance, Adelaide, SA Australia
- School of Medicine, University of Adelaide, Adelaide, SA Australia
- School of Biological Sciences, University of Adelaide, Adelaide, SA Australia
- ACRF Cancer Genomics Facility, Centre for Cancer Biology, SA Pathology, Adelaide, SA Australia
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA Australia
| | - David J. Torpy
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA Australia
- School of Medicine, University of Adelaide, Adelaide, SA Australia
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Marei MM, Fares AE, Abdelsattar AH, Abdullateef KS, Seif H, Hassan MM, Elkotby M, Eltagy G, Elbarbary MM. Anatomical measurements of the urogenital sinus in virilized female children due to congenital adrenal hyperplasia. J Pediatr Urol 2016; 12:282.e1-8. [PMID: 26994589 DOI: 10.1016/j.jpurol.2016.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 02/06/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Virilized females due to congenital adrenal hyperplasia represent the most common form of female disorders of sexual development. The anomaly therein is an external virilization to resemble male genitalia and a persistent urogenital sinus. OBJECTIVES To study the anatomical details of the virilized female cases operated upon between 2011 and 2015. This anatomical description is presented to support the current surgical strategy of partial urogenital mobilization to correct this anomaly. METHODS Thirty cases (presenting to a single tertiary center) were prospectively studied by genitography, cysto-urethroscopy, and operated upon via a single-stage feminizing genitoplasty. A single surgical team operated upon all cases. External virilization was assessed by the Prader classification. The internal anatomy was studied by measuring the length of the urethra proximal to the confluence, and the vertical depth of the vaginal-urethral confluence from the perineum. The correlation coefficients between the external virilization and the internal anatomical measurements were derived. RESULTS The median age at surgery was 19 months (range 6-42 months). External virilization did not obviously correlate with the length of the proximal (prejunctional) urethra (r = -0.03, P = 0.5), or strongly with the depth of the vaginal-urethral confluence (r = 0.2, P = 0.2). The mean length of the proximal urethra was 22 mm (range 10-32 mm), and the mean vertical depth of the vaginal-urethral confluence from the perineum was 16 mm (range 8-31 mm). DISCUSSION Due to limitations of the radiological and endoscopic evaluation, the accurate anatomical assessment of this condition may be challenging. In order to assess or compare the anatomy of these cases, there are two important points to address: (1) the length of the urethra proximal to the urogenital sinus, as this will impact the urinary outcome; and (2) the depth (level) of vaginal entry into the urogenital sinus, as this will affect the mobilization required to exteriorize the vagina. CONCLUSION The degree of external virilization does not totally correlate with the internal anatomy. The depth of the vaginal-urethral confluence from the perineum is an indicator of the required mobilization for the current perineal approach. In 90% of cases in this age group (1-3 years old), this depth is ≤20 mm. This supports the current understanding that partial urogenital mobilization could be suitable for most cases Figure (Summary).
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Zeng L, Zhang J, Huang G, Huang Y, Ma X, Huang L. [CLITOROPLASTY FOR GENITAL VIRILIZATION IN GIRLS WITH CONGENITAL ADRENAL HYPERPLASIA]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2016; 30:1134-1138. [PMID: 29786370 DOI: 10.7507/1002-1892.20160231] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the effectiveness of clitoroplasty of reserving the clitoris dorsal neurovascular bundle and the ventral complete urethral plate for genital virilization in girls with congenital adrenal hyperplasia (CAH). METHODS Between June 2000 and October 2015, 27 girls with genital virilization were treated with clitoroplasty of reserving the clitoris dorsal neurovascular bundle and the ventral complete urethral plate. The chromosomal karyotype was 46, XX in all patients, whose age ranged from 3 to 11 years (mean, 3.9 years). According to Parder's virilization scale, 5 cases were classified as stage Ⅱ, 18 cases as stage Ⅲ, and 4 cases as stage Ⅳ. The hormone tests showed decreased cortisol level and increased testosterone and 17-hydroxyprogesterone levels. They were diagnosed with non-salt-wasting CAH. RESULTS All of the patients underwent clitoroplasty successfully. The mean operation time was 74 minutes (range, 58-95 minutes). Incision healed primarily. The patients were followed up 6 months to 10 years (median, 19 months). The external genitalia had good appearance, without necrosis of flap and the glans clitoris, abnormal sensation of the glans clitoris, or clitorism recurrence. Five girls had breast development and normal menstrual cycle during adolescence, and 1 patient who was followed up for 10 years gave birth to a son. CONCLUSIONS Clitoroplasty of reserving the clitoris dorsal neurovascular bundle and the ventral complete urethral plate is a relatively ideal method for treating genital virilization in girls. It has less complications, good aesthetic and functional results. There are satisfactory outcomes when combining with the endocrine treatment.
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Affiliation(s)
- Li Zeng
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
| | - Jie Zhang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
| | - Guizhen Huang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
| | - Yidong Huang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
| | - Xue Ma
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
| | - Lugang Huang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
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Nickel JC, Gorin MA, Alan W P, Loeb S, Ellen S, Chancellor MB, Assimos DG, Brawer MK, Brucker BM. Best of the 2016 AUA Annual Meeting: Highlights From the 2016 American Urological Association Annual Meeting, May 6-10, 2016, San Diego, CA. Rev Urol 2016; 18:159-173. [PMID: 27833468 PMCID: PMC5102934 DOI: 10.3909/riu0717] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | | | | | | | | | | | - Dean G Assimos
- University of Alabama at Birmingham School of Medicine Birmingham, AL
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Abstract
Studies estimate that the incidence of genital anomalies could be as high as 1 in 300 births. While it is rare for an infant to present with truly ambiguous genitalia, it is plausible that the pediatric nurse will encounter a patient with disorders of sexual development in his or her career. Cases of disorders of sexual development are challenging due to complexities of diagnosis, gender assignment, uncertain outcomes, treatment options, and psychosocial stressors. This article discusses the evaluation and management of children with disorders of sexual development and the nurse's role as child advocate and family educator.
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Shalaby MM, Kurkar A, Zarzour MA, Faddan AA, Khalil M, Abdelhafez MF. The management of the persistent Müllerian duct syndrome. Arab J Urol 2014; 12:239-44. [PMID: 26019957 PMCID: PMC4435512 DOI: 10.1016/j.aju.2014.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/30/2014] [Accepted: 04/02/2014] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To report the findings and management of patients with persistent Müllerian duct syndrome (PMDS). PATIENTS AND METHODS Nineteen phenotypically male patients (aged 8 months to 27 years) presented with testicular maldescent. All of them had normal male external genitalia. Two of them had had a previous diagnosis of persistent Müllerian structures. All patients were karyotyped, and had a hormonal profile, diagnostic laparoscopy, retrograde urethrocystogram, gonadal biopsies, and surgical management according to the findings. The follow-up was based on a clinical examination, abdominal ultrasonography (US) and scrotal colour-Doppler US at 3 and 6 months after surgery, and every 6 months thereafter. RESULTS Diagnostic laparoscopy showed the presence of persistent Müllerian structures in all 19 patients. All patients had a normal male karyotype (46XY). Ten patients had a laparoscopic excision of their Müllerian structures while the remaining nine patients had their Müllerian structures left in place. No malignant changes were found in the excised Müllerian tissues. Of the 37 gonadal biopsies taken, 31 (84%) indicated normal testes. CONCLUSIONS The incidence and prevalence of PMDS are not well estimated. Müllerian structures should be removed whenever possible to avoid the risk of malignant transformation. The early diagnosis of PMDS makes possible the excision of Müllerian structures and a primary orchidopexy. A long-term follow-up is needed for patients with intact Müllerian structures and magnetic resonance imaging might be a better method than US for that purpose. Most of the patients had normal testicular histology, which might allow fertility.
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Affiliation(s)
- Mahmoud M Shalaby
- Urology Department, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Adel Kurkar
- Urology Department, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Mohamed A Zarzour
- Urology Department, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Amr A Faddan
- Urology Department, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Mahmoud Khalil
- Urology Department, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Mohamed F Abdelhafez
- Urology Department, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
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Abstract
Hypospadias, epispadias with or without exstrophy, and disorders of sex development are among the most common anomalies of genitalia that occur during childhood. Considering the tremendous effect of genitourinary reconstruction on adult life, the evaluation of the long-term results of different techniques of genitoplasty in pediatrics is of the utmost importance. After reviewing the literature, the authors summarize the available long-term outcomes of genitoplasty in childhood, specifically focusing on the cosmetic, psychosocial, psychosexual and functional results, and emphasize that, contrary to the widely available data on early outcomes of genital reconstruction in the pediatric population, very few well described controlled studies have evaluated the long-term effect of genitoplasty in puberty and adulthood, in the sense that the surgeon should describe the peroperative findings in more detail and also be more structured in evaluating the postoperative result at follow-up visits. Finally, the authors conclude that more attention should be paid to the impact of these techniques on cosmetic aspects and psychosexual development in these patients after puberty, as they play a crucial role in their adult quality of life.
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Jouyan N, Davoudi Dehaghani E, Senemar S, Shojaee A, Mozdarani H. Sex chromosome aneuploidy in cytogenetic findings of referral patients from south of Iran. Iran J Reprod Med 2012; 10:141-8. [PMID: 25242988 PMCID: PMC4163277] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 11/09/2010] [Accepted: 05/18/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chromosome abnormality (CA) including Sex chromosomes abnormality (SCAs) is one of the most important causes of disordered sexual development and infertility. SCAs formed by numerical or structural alteration in X and Y chromosomes, are the most frequently CA encountered at both prenatal diagnosis and at birth. OBJECTIVE This study describes cytogenetic findings of cases suspected with CA referred for cytogenetic study. MATERIALS AND METHODS Blood samples of 4151 patients referred for cytogenetic analysis were cultured for chromosome preparation. Karyotypes were prepared for all samples and G-Banded chromosomes were analyzed using x100 objective lens. Sex chromosome aneuploidy cases were analyzed and categorized in two groups of Turners and Klinefelter's syndrome (KFS). RESULTS Out of 230 (5.54%) cases with chromosomally abnormal karyotype, 122 (30%) cases suspected of sexual disorder showed SCA including 46% Turner's syndrome, 46% KFS and the remaining other sex chromosome abnormalities. The frequency of classic and mosaic form of Turner's syndrome was 33% and 67%, this was 55% and 45% for KFS, respectively. CONCLUSION This study shows a relatively high sex chromosome abnormality in this region and provides cytogenetic data to assist clinicians and genetic counselors to determine the priority of requesting cytogenetic study. Differences between results from various reports can be due to different genetic background or ethnicity.
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Affiliation(s)
- Najmeh Jouyan
- Human Genetic Research Group, Iranian Academic Center for Education, Culture and Research, Fars Province Branch, Shiraz, Iran.
- Institute of Biochemistry and Biophysics, Tehran University, Tehran, Iran.
| | - Elham Davoudi Dehaghani
- Human Genetic Research Group, Iranian Academic Center for Education, Culture and Research, Fars Province Branch, Shiraz, Iran.
| | - Sara Senemar
- Human Genetic Research Group, Iranian Academic Center for Education, Culture and Research, Fars Province Branch, Shiraz, Iran.
| | - Ashraf Shojaee
- Human Genetic Research Group, Iranian Academic Center for Education, Culture and Research, Fars Province Branch, Shiraz, Iran.
| | - Hossein Mozdarani
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
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