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Pomahacova R, Zamboryova J, Paterova P, Krepelova A, Subrt I, Jaklova R, Vohradska P, Hrdonkova E, Sykora J. Late diagnosis of complete androgen insensitivity syndrome and transmission/carriers of the condition in a family with mutation c.2495G> T p.(Arg832Leu) in exon 7 of the androgen receptor gene: genetic, clinical and ethical aspects. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 163:379-382. [PMID: 30401990 DOI: 10.5507/bp.2018.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/17/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The complete androgen insensitivity syndrome (CAIS) is a rare genetic disorder causing insensitivity to androgens in a person with female phenotype and 46,XY karyotype due to a mutation in the androgen receptor gene located on chromosome X. These children are born with female external genitalia, and females are transmitters. CASE REPORT We illustrate an unexpected diagnosis of CAIS in two siblings during examination for short stature, and describe transmission/carriers in the family along with ethical aspects. CONCLUSION A genetic examination could have earlier revealed the transmission of c.2495G>Tp.(Arg832Leu) mutation in exon 7. Our experience highlights the possibility of prenatal testing for the management of pregnancy in a family with a history of CAIS. The implications of prenatal testing in relation to CAIS with clearer explication of ethical and clinical issues warrant further investigation.
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Affiliation(s)
- Renata Pomahacova
- Department of Pediatrics, Faculty of Medicine in Pilsen, Charles University in Prague and Faculty Hospital, Pilsen, Czech Republic
| | - Jana Zamboryova
- Department of Pediatrics, Faculty of Medicine in Pilsen, Charles University in Prague and Faculty Hospital, Pilsen, Czech Republic
| | - Petra Paterova
- Department of Pediatrics, Faculty of Medicine in Pilsen, Charles University in Prague and Faculty Hospital, Pilsen, Czech Republic
| | - Anna Krepelova
- Department of Biology and Medical Genetics, 2 nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic
| | - Ivan Subrt
- Institute of Medical Genetics, Faculty of Medicine in Pilsen, Charles University in Prague and Faculty Hospital, Pilsen, Czech Republic
| | - Radka Jaklova
- Institute of Medical Genetics, Faculty of Medicine in Pilsen, Charles University in Prague and Faculty Hospital, Pilsen, Czech Republic
| | - Petra Vohradska
- Institute of Medical Genetics, Faculty of Medicine in Pilsen, Charles University in Prague and Faculty Hospital, Pilsen, Czech Republic
| | - Eliska Hrdonkova
- Department of Gynecology, Faculty of Medicine in Pilsen, Charles University in Prague and Faculty Hospital, Pilsen, Czech Republic
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Complete androgen sensitivity syndrome. Diagn Interv Imaging 2015; 96:121-5. [DOI: 10.1016/j.diii.2014.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Gibor U, Ohana E, Elena D, Kirshtein B. Inguinal hernia as a presentation of testicular feminization. Hernia 2014; 19:677-9. [PMID: 24867617 DOI: 10.1007/s10029-014-1265-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 05/14/2014] [Indexed: 11/24/2022]
Abstract
We present a case of a 20-year-old female who was admitted to our department for an elective inguinal hernia repair. An oval-shaped mass was found in the hernia sac during the surgery that was suspected to be an ovary. Histological examination revealed testicular tissue. Further evaluation confirmed testicular feminization. She underwent laparoscopic orchiectomy and hernia repair from the contralateral side 3 months later.
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Affiliation(s)
- Udit Gibor
- Department of Surgery "A", Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, POB 151, 84101, Beersheba, Israel
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Cheikhelard A, Thibaud E, Morel Y, Jaubert F, Lortat-Jacob S, Polak M, Nihoul-Fekete C. Complete androgen insensitivity syndrome: diagnosis and management. Expert Rev Endocrinol Metab 2009; 4:565-573. [PMID: 30780790 DOI: 10.1586/eem.09.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Complete androgen insensitivity syndrome (CAIS) is an X-linked genetic disorder affecting 46,XY individuals, characterized by the loss of function of the androgen receptor gene resulting in complete peripheral androgen resistance. Patients have a nonambiguous female phenotype with normal female external genitalia. Gonads are undescended testes (either intra-abdominal or inguinal), there is no uterus and the length of the vagina is usually very short. Gender identity is always female. This review focuses on the importance of accurate diagnosis of CAIS versus partial androgen insensitivity syndrome and other disorders of sex development by genotyping the androgen receptor, and raises issues of the optimal management of these patients. In the era of the Consensus Statement on Management of Intersex Disorders, we provide new insights into CAIS screening, surgical management of the gonads (balancing between hormonal production and malignancy risk) and of vaginal adequacy, and the ethics concerned with the disclosure to patients and their families.
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Affiliation(s)
- Alaa Cheikhelard
- a Department of Pediatric Surgery and Urology, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France and Centre de Référence des Pathologies Gynécologiques Rares, AP-HP Hôpital Necker Enfants-malades, Paris, France.
| | - Elisabeth Thibaud
- b Department of Pediatric Endocrinology and Gynaecology, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France and Centre de Référence des Pathologies Gynécologiques Rares, AP-HP Hôpital Necker Enfants-malades, Paris, France
| | - Yves Morel
- c Department of Molecular Biology and Hormonology, Université Claude Bernard Lyon 1, Lyon, France
| | - Francis Jaubert
- d Department of Cytology and Pathology, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, Paris, France and Université Paris Descartes, Paris, France
| | - Stephen Lortat-Jacob
- e Department of Pediatric Surgery and Urology, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France
| | - Michel Polak
- f Centre de Référence des Pathologies Gynécologiques Rares, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France and Department of Pediatric Endocrinology and Gynaecology, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France and Université Paris Descartes, Paris, France
| | - Claire Nihoul-Fekete
- g Department of Pediatric Surgery and Urology and Centre de Référence des Pathologies Gynécologiques Rares, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France and Université Paris Descartes, Paris, France
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Stewart CJR, Baker E, Beaton C, Crook M, Peverall J, Wallace S. Detection of Y-chromosome in gonadal tumours using fluorescence in situ hybridization: diagnostic value in intersex conditions including older patients with clinically unsuspected androgen insensitivity syndrome. Histopathology 2007; 52:175-82. [DOI: 10.1111/j.1365-2559.2007.02927.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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