1
|
Fiorini A, Sepich M, Pontrelli M, Sangriso G, Cosci O Di Coscio M, Lauletta M, Baldinotti F, Peroni D, Ambrosio MR, Bertelloni S. Adolescent Gynecomastia due to Minimal Androgen Resistance Syndrome: A Case Report and Literature Review. Sex Dev 2021; 14:21-26. [PMID: 33691326 DOI: 10.1159/000514067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/25/2020] [Indexed: 11/19/2022] Open
Abstract
A 14-year-old boy with a 46,XY karyotype and persistent breast-3-stage gynecomastia is reported. The reproductive axis was investigated by standard laboratory methods and the androgen receptor (AR) gene was sequenced. Also, a literature review of phenotypes associated with the AR genetic variant p.Pro392Ser was performed. The boy presented with height in the upper normal range (+1.9 SDS) and normal body mass index (-0,3 SDS); pubertal development was PH5/G4 (mean testicular volume 15 mL; 0 SDS). Laboratory findings were normal for age and sex, except aromatization index (0.09; reference range 0.03-0.07). Analysis of the AR gene showed the single nucleotide variant c.1174C>T (p.Pro392Ser) in exon 1, leading to the diagnosis of minimal androgen insensitivity syndrome (AIS). This genetic variant is reported in other 8 patients with AIS and is associated with variable clinical phenotypes ranging from complete to partial and minimal AIS. To the best of our knowledge, this is the first adolescent in whom the p.Pro392Ser mutation is associated with isolated persistent gynecomastia. The underlying reason of phenotypic variability due to this AR mutation remains unknown. Persistent gynecomastia due to minimal AIS has been reported in few additional males with variable AR mutations. Since fertility troubles may occur in adult men with minimal AIS, early diagnosis can allow optimizing the clinical management.
Collapse
Affiliation(s)
- Aureliano Fiorini
- Division of Pediatrics, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Margherita Sepich
- Division of Pediatrics, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Margherita Pontrelli
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giorgio Sangriso
- Division of Pediatrics, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Mirna Cosci O Di Coscio
- Division of Pediatrics, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Marcella Lauletta
- Division of Pediatrics, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Fulvia Baldinotti
- Section of Molecular Genetics, Department of Laboratory Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Diego Peroni
- Division of Pediatrics, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Maria Rosaria Ambrosio
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Silvano Bertelloni
- Division of Pediatrics, Department of Obstetrics, Gynecology and Paediatrics, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy,
| |
Collapse
|
2
|
Schwentner C, Czyz J, Seibold J, Todenhoefer T, Alloussi SH, Klocker H, Gakis G, Stenzl A, Baka-Ostrowska M, Radmayr C. Long-term biochemical evaluation of the androgen receptor pathway in males with disorders of sex development. World J Urol 2010; 29:677-82. [PMID: 21161538 DOI: 10.1007/s00345-010-0622-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 11/17/2010] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Disorders of sex (DSD) development represent a serious condition. Most of the underlying mechanisms remain unclear. Disturbances within the androgen receptor (AR) pathway frequently account for 46 XY-DSDs. The individual gender-related outcome often is unsatisfactory. We present a long-term AR gene-mutation-associated follow-up in a group of 46 XY-DSD patients. METHODS Twenty patients (46 XY) who underwent genitoplasty in infancy or early childhood were retrospectively identified. Median follow-up after surgery was 16 years. All were undervirilized at initial presentation. Thirteen had female gender assignment, and 7 were raised as males. A genital skin biopsy and subsequent fibroblast cultures were done. The specific binding of dihydrotestosterone, the thermostability of the receptor hormone complex, and 5-α-reductase activity were measured. AR gene mutations were detected by direct sequencing. The individual outcome was correlated with specific AR mutations. RESULTS AR point mutations were detected in 12, 7 were previously unknown. There was no specific androgen binding in 3, reduced affinity in 9, and normal binding in 8 patients. 5-α-Reductase activity was normal in 15, reduced in 4 and completely absent in 1 patient. CONCLUSIONS Retrospective evaluation revealed previously unknown and established AR gene mutations being associated with a distinct long-term outcome. Identification of the molecular mechanisms causing DSD will likely improve timely diagnosis and therapy. Exact characterization of AR activation and function may offer a treatment modality in affected patients. These data may allow us to give prognostic estimations on the individual outcome adding objective criteria for gender assignment in 46 XY-DSD patients.
Collapse
Affiliation(s)
- C Schwentner
- Department of Pediatric Urology, Medical University Innsbruck, Innsbruck, Austria.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Isolated micropenis reveals partial androgen insensitivity syndrome confirmed by molecular analysis. Asian J Androl 2010; 12:561-6. [PMID: 20305676 DOI: 10.1038/aja.2010.6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Partial androgen insensitivity syndrome (PAIS) is the milder variant of androgen receptor (AR) defects. The subtle effects of AR mutations present in a patient with micropenis, peno-scrotal hypospadias, infertility, clitoromegaly and posterior labial fusion. We studied the association of isolated micropenis with the genetic defects resulting in androgen resistance, that is, AR gene defects and 5-alpha reductase type 2 (SRD5A2) deficiency. We describe two cases of isolated micropenis: one in a 14-year-old boy and the other in a 3-year-old boy who was followed until he was 10 years old. There were no findings of hypospadias, cryptorchidism or gynecomastia in either of these patients. Serum gonadotrophin and androgen levels were obtained and karyotyping was done. Human chorionic gonadotropin (hCG) stimulation testing assessed the functional capacity of the testes. DNA was extracted from peripheral leukocytes, and all exons of the SRD5A2 and AR genes were amplified by polymerase chain reaction and sequenced. In both patients, baseline testosterone (T) level was low and the values were elevated after hCG testing. The sequence of the SRD5A2 gene was normal in patient 1, and a heterozygous polymorphism, V89L, was found in patient 2. Two known mutations, P390S and A870V, were identified in patients 1 and 2, respectively. Mutations in the AR gene can be associated with isolated micropenis without other features of PAIS, such as hypospadias or gynecomastia. This underlines the importance of including AR gene analysis in the evaluation of isolated micropenis with normal plasma T to ensure proper management of the patient and appropriate genetic counseling for the family.
Collapse
|
4
|
Basrur PK. Disrupted sex differentiation and feminization of man and domestic animals. ENVIRONMENTAL RESEARCH 2006; 100:18-38. [PMID: 16209866 DOI: 10.1016/j.envres.2005.08.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Revised: 08/09/2005] [Accepted: 08/23/2005] [Indexed: 05/04/2023]
Abstract
Genital malformations constitute the most common birth defects in man and domestic animals and occur frequently in males since the participation of many genes is required for sex differentiation to proceed in the male direction. The precise dose, timing, and coordination needed for their expression add to the proneness of various stages in male sex differentiation to external influences. The emerging insight, through the identification of genes involved in the sex differentiation cascade, is that over 85% of sex anomalies in human and domestic animal populations are not attributable to chromosome aberrations or to mutations in a known gene. Since a majority of severely malformed individuals are incapable of reproduction, the high rates of these defects have to be results either of new mutations or of collaboration of environmental factors with genes. Increase in specific malformations in domestic animals often indicates increased concentration of liability genes brought together in the conceptus by inbreeding. However, in human populations where inbreeding is not the norm such increases may reflect environment-induced new mutations or interaction of environmental agents with hormone-sensitive genes. This review summarizes the information currently available on the genetics of major events in male sex differentiation and briefly discusses the collaborative role that environment may play in disrupting different components of this process.
Collapse
Affiliation(s)
- Parvathi K Basrur
- Department of Biomedical Sciences, University of Guelph, Guelph, Ont., Canada N1G 2W1
| |
Collapse
|
5
|
Ledig S, Jakubiczka S, Neulen J, Aulepp U, Burck-Lehmann U, Mohnike K, Thiele H, Zierler H, Brewer C, Wieacker P. Novel and Recurrent Mutations in Patients with Androgen Insensitivity Syndromes. Horm Res Paediatr 2005; 63:263-9. [PMID: 15925895 DOI: 10.1159/000086018] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Accepted: 03/22/2005] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/AIMS Androgen insensitivity syndrome (AIS) caused by mutations within the androgen receptor gene represents a variety of phenotypes from females with 46,XY karyotype over individuals with ambiguous genitalia to infertile males. METHODS We studied 24 patients with AIS by sequencing androgen receptor gene. 19 of the investigated patients were affected by complete androgen insensitivity syndrome (CAIS) and 5 suffered from partial androgen insensitivity syndrome (PAIS). RESULTS So far we have detected 12 unreported mutations as well as 9 recurrent mutations (3 recurrent mutations were detected twice) in exons 2-8 of the androgen receptor gene. Three of the novel mutations cause a frameshift with subsequent premature termination and were found in patients with CAIS. These frameshifts were induced by single nucleotide deletion or insertion, or in one case by a 13-bp deletion, respectively. Another premature stop codon found in a CAIS patient results from an already reported nucleotide substitution in exon 5. Furthermore, in a CAIS patient we found a novel duplication of codon 788. All other mutations caused single base substitutions spread through exons 2-8 and were associated with CAIS or PAIS. CONCLUSIONS We report a broad spectrum of different mutations within the AR gene leading to various manifestations of AIS. Apart from truncating mutations, a reliable genotype/phenotype correlation cannot be established. Therefore, modifying factors must be effective.
Collapse
Affiliation(s)
- Susanne Ledig
- Institut für Humangenetik der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Deeb A, Mason C, Lee YS, Hughes IA. Correlation between genotype, phenotype and sex of rearing in 111 patients with partial androgen insensitivity syndrome. Clin Endocrinol (Oxf) 2005; 63:56-62. [PMID: 15963062 DOI: 10.1111/j.1365-2265.2005.02298.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Partial androgen insensitivity syndrome (PAIS) is a heterogeneous group of intersex disorders characterized by a typical perineoscrotal hypospadias/micropenis phenotype, and a normal androgen-producing testis. Various mutations in the androgen receptor (AR) are known to cause PAIS. Phenotypic expression is widely variable and there are no agreed guidelines to determine the sex of rearing in individuals with borderline masculinization. We aimed to quantitatively assess the external genital phenotype in relation to AR genotype and sex of rearing and identify criteria that differentiate mutation positive (ARmt) from mutation negative (ARwt) PAIS patients. PATIENTS AND DESIGN Cases with a diagnosis of PAIS were identified from the Cambridge Intersex Database. An external masculinization score (EMS) was used to quantify the degree of undermasculinization. Family history of AIS and details of the sex of rearing were recorded. Androgen binding was analysed in fibroblasts obtained from genital skin biopsies and mutational analysis of the AR was performed on genomic DNA extracted from peripheral blood. EMS and sex of rearing were compared in cases with similar mutations reported on the McGill International Database. RESULTS Two hundred and sixty-three patients with PAIS were identified. Androgen receptor gene sequencing was performed in 111 patients. Twenty-seven (24%) had mutations. Family history of AIS was present in 61 and 21% of ARmt and ARwt patients, respectively. The median EMS was 3 in both groups. The majority of ARmt patients had abnormal binding and there was a tendency to a higher median testosterone rise on hCG stimulation in ARmt (9.3 nmol/l) compared with ARwt patients (6.9 nmol/l). All patients with EMS of 4 or more were raised as male but there was an overlap of sex of rearing in patients with an EMS less than 4. A wide variation of EMS in relation to genotype and sex of rearing was observed. CONCLUSION The phenotype in PAIS is extremely variable and is rarely predicted by the AR genotype. Apart from the family history, there are no specific criteria to differentiate ARwt from ARmt. Sex of rearing is not entirely dependent on the EMS. Cultural issues, other modifying genes and response to androgen trials might be influencing factors. Collaborative studies with uniform protocols are needed to investigate infants with PAIS. Documenting phenotype, surgical procedures and outcome criteria are necessary to enable decision-making on the sex of rearing in patients with a lower range EMS.
Collapse
Affiliation(s)
- A Deeb
- University Department of Paediatrics, Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge, UK
| | | | | | | |
Collapse
|
7
|
Vilchis F, Ramos L, Kofman-Alfaro S, Zenteno JC, Méndez JP, Chávez B. Extreme androgen resistance in a kindred with a novel insertion/deletion mutation in exon 5 of the androgen receptor gene. J Hum Genet 2003; 48:346-51. [PMID: 12908100 DOI: 10.1007/s10038-003-0036-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2002] [Accepted: 04/12/2003] [Indexed: 10/26/2022]
Abstract
Androgen insensitivy syndrome (AIS) is the most frequent cause of male pseudohermaphroditism resulting from target-organ resistance to androgen action. Individuals bearing the complete form of the disease (CAIS) present a female phenotype and a lack of pubic and axillary hair. In the present study, four 46,XY patients born in two generations from a kindred with a history of AIS were examined for genetic abnormalities in the androgen receptor gene (AR). All eight exons encoding the AR protein were individually amplified from genomic DNA followed by a mutation screening with single-strand conformation polymorphism analysis. Sequencing of the mutant AR revealed a novel insertion/deletion mutation in exon 5. A deletion of 7 bp is replaced by an insertion of 11 nucleotides, which represents a duplication of the adjacent downstream sequence. The mutation g.2640_2646delAGGATGC/2652_2662insTTCGCCCCTGA, results in a frameshift that introduces a premature termination signal TGA, nine codons downstream. Such a rearrangement predicts a truncation of the AR, thereby deleting a large portion of the ligand-binding domain (amino acid position 768-919). Furthermore, although this mutation breaks the translational reading frame starting from codon 760, examination of the complementary DNA suggested that it does not disturb mRNA splicing. These changes have been found in all the patients and appear to account for the observed absence of detectable androgen binding to the AR in cultured fibroblasts and for the CAIS phenotype in the kindred. This disorder represents the first insertion/deletion mutation of the AR that probably arose by a slipped-strand mispairing mechanism.
Collapse
Affiliation(s)
- Felipe Vilchis
- Department of Reproductive Biology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlalpan C.P. 14000, México D.F., México.
| | | | | | | | | | | |
Collapse
|
8
|
Nguyen V, Sadler GR, Shi M, Gilpin EA, Cruz LA, Blas LA, Blas TLA, Acfalle RMC, Acfalle BAC. Cancer risk factor assessment among Chamorro women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2003; 18:100-6. [PMID: 12888385 DOI: 10.1207/s15430154jce1802_13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Little is known about the health of Chamorros residing in the United States. METHODS The Chamorro Directory International and CDC's Behavioral Risk Factor Surveillance System were used to assess behavioral risk factors and health needs of San Diego's Chamorro women. RESULTS Of 128 Chamorro women, 42.2% reported having a total frequency of five or more fruits and vegetables daily, 54.5% reported being current on their colorectal cancer screening, and 9.4% smoke. CONCLUSIONS While this sample of Chamorro women reported higher rates of healthpromoting practices than nationwide averages, significant health improvement opportunities remain.
Collapse
Affiliation(s)
- Victori Nguyen
- Moores UCSD Cancer Centre, University of California at San Diego School of Medicine, USA
| | | | | | | | | | | | | | | | | |
Collapse
|