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Nwosu BU. Editorial: Stars and rising stars in pediatric endocrinology: 2022. Front Endocrinol (Lausanne) 2024; 15:1384549. [PMID: 38562411 PMCID: PMC10982425 DOI: 10.3389/fendo.2024.1384549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/19/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- Benjamin Udoka Nwosu
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Chief of Endocrinology, Cohen Children’s Medical Center of New York, Director, Children’s Diabetes Center, Lake Success, NY, United States
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2
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Zhanghuang C, Long N, Yang Z, Xie Y. Bilateral adrenal giant medullary lipoma combined with disorders of sex development: a rare case report and literature review. Front Oncol 2023; 13:1210679. [PMID: 37681022 PMCID: PMC10482419 DOI: 10.3389/fonc.2023.1210679] [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: 04/23/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023] Open
Abstract
Bilateral adrenal myelolipoma is rare in clinics and patients with disorders of sex development (DSDs). One case was reported in our center. A 45-year-old patient was admitted to the hospital after discovering a left abdominal mass for more than a year and worsening abdominal pain for 18 days. An imaging examination showed bilateral adrenal masses. Physical examination showed clitoris hypertrophy with patelliform changes, thick and dense pubic hair, normal development of bilateral labia majora without labia minora, and urethral opening. After the relevant preoperative examinations, bilateral adrenal mass resection was performed under general anesthesia. The postoperative pathology confirmed adrenal myelolipoma. The incision healed well without recurrence over 10 years after the operation. Her enlarged clitoris decreased in size. This case report has a detailed diagnosis and treatment process and sufficient examination results. It can provide a reference for diagnosing and treating patients with bilateral adrenal myelolipoma and DSD and reduce the risk of misdiagnosis and mistreatment.
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Affiliation(s)
- Chenghao Zhanghuang
- Department of Urology, Kunming Children’s Hospital, Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming, China
- Yunnan Key Laboratory of Children’s Major Disease Research, Yunnan Clinical Medical Center for Pediatric Diseases, Kunming Children’s Hospital, Kunming, China
| | - Na Long
- Special Ward, Kunming Children’s Hospital, Yunnan Province Clinical Research Center for Children’s Health and Disease, Kunming, China
| | - Zhen Yang
- Department of Oncology, Yunnan Children Solid Tumor Treatment Center, Kunming Children’s Hospital, Kunming, China
| | - Yucheng Xie
- Department of Pathology, Kunming Children’s Hospital, Kunming, China
- Department of Pathology, The Second People’s Hospital of Yunnan Province, Kunming, China
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3
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Chen Z, Li P, Lyu Y, Wang Y, Gao K, Wang J, Lan F, Chen F. Molecular genetics and general management of androgen insensitivity syndrome. Intractable Rare Dis Res 2023; 12:71-77. [PMID: 37287652 PMCID: PMC10242393 DOI: 10.5582/irdr.2023.01024] [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: 03/21/2023] [Revised: 04/25/2023] [Accepted: 05/15/2023] [Indexed: 06/09/2023] Open
Abstract
Androgen insensitivity syndrome (AIS) is a rare genetic disorder that affects the development of the male reproductive system in individuals with a 46,XY karyotype. In addition to physical impacts, patients with AIS may face psychological distress and social challenges related to gender identity and acceptance. The major molecular etiology of AIS results from hormone resistance caused by mutations in the X-linked androgen receptor (AR) gene. Depending on the severity of androgen resistance, the wide spectrum of AIS can be divided into complete AIS (CAIS), partial AIS (PAIS), or mild AIS (MAIS). Open issues in the treatment and management of AIS include decisions about reconstructive surgery, genetic counseling, gender assignment, timing of gonadectomy, fertility and physiological outcomes. Although new genomic approaches have improved understanding of the molecular causes of AIS, identification of individuals with AIS can be challenging, and molecular genetic diagnosis is often not achievable. The relationship between AIS genotype and phenotype is not well established. Therefore, the optimal management remains uncertain. The objective of this review is to outline the recent progress and promote understanding of AIS related to the clinical manifestation, molecular genetics and expert multidisciplinary approach, with an emphasis on genetic etiology.
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Affiliation(s)
- Zhongzhong Chen
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Clinical Research Center for Hypospadias Pediatric College, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Urogenital Development Research Center, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Pin Li
- Department of Endocrinology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiqing Lyu
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yaping Wang
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kexin Gao
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Wang
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fuying Lan
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fang Chen
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Clinical Research Center for Hypospadias Pediatric College, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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4
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Ning D, Zhang Z, Qiu K, Lu L, Zhang Q, Zhu Y, Wang R. Efficacy of intelligent diagnosis with a dynamic uncertain causality graph model for rare disorders of sex development. Front Med 2020; 14:498-505. [PMID: 32681210 DOI: 10.1007/s11684-020-0791-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 07/17/2020] [Indexed: 11/26/2022]
Abstract
Disorders of sex development (DSD) are a group of rare complex clinical syndromes with multiple etiologies. Distinguishing the various causes of DSD is quite difficult in clinical practice, even for senior general physicians because of the similar and atypical clinical manifestations of these conditions. In addition, DSD are difficult to diagnose because most primary doctors receive insufficient training for DSD. Delayed diagnoses and misdiagnoses are common for patients with DSD and lead to poor treatment and prognoses. On the basis of the principles and algorithms of dynamic uncertain causality graph (DUCG), a diagnosis model for DSD was jointly constructed by experts on DSD and engineers of artificial intelligence. "Chaining" inference algorithm and weighted logic operation mechanism were applied to guarantee the accuracy and efficiency of diagnostic reasoning under incomplete situations and uncertain information. Verification was performed using 153 selected clinical cases involving nine common DSD-related diseases and three causes other than DSD as the differential diagnosis. The model had an accuracy of 94.1%, which was significantly higher than that of interns and third-year residents. In conclusion, the DUCG model has broad application prospects as a computer-aided diagnostic tool for DSD-related diseases.
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Affiliation(s)
- Dongping Ning
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Department of Pediatrics, Linfen Central Hospital, Linfen, 041000, China
| | - Zhan Zhang
- Institute of Nuclear and New Energy Technology, Tsinghua University, Beijing, 100084, China
| | - Kun Qiu
- Institute of Nuclear and New Energy Technology, Tsinghua University, Beijing, 100084, China
| | - Lin Lu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Qin Zhang
- Department of Computer Science and Technology, Tsinghua University, Beijing, 100084, China.
| | - Yan Zhu
- Institute of Internet Industry, Tsinghua University, Beijing, 100084, China
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
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5
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McElreavey K, Jorgensen A, Eozenou C, Merel T, Bignon-Topalovic J, Tan DS, Houzelstein D, Buonocore F, Warr N, Kay RGG, Peycelon M, Siffroi JP, Mazen I, Achermann JC, Shcherbak Y, Leger J, Sallai A, Carel JC, Martinerie L, Le Ru R, Conway GS, Mignot B, Van Maldergem L, Bertalan R, Globa E, Brauner R, Jauch R, Nef S, Greenfield A, Bashamboo A. Pathogenic variants in the DEAH-box RNA helicase DHX37 are a frequent cause of 46,XY gonadal dysgenesis and 46,XY testicular regression syndrome. Genet Med 2020; 22:150-159. [PMID: 31337883 PMCID: PMC6944638 DOI: 10.1038/s41436-019-0606-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/01/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE XY individuals with disorders/differences of sex development (DSD) are characterized by reduced androgenization caused, in some children, by gonadal dysgenesis or testis regression during fetal development. The genetic etiology for most patients with 46,XY gonadal dysgenesis and for all patients with testicular regression syndrome (TRS) is unknown. METHODS We performed exome and/or Sanger sequencing in 145 individuals with 46,XY DSD of unknown etiology including gonadal dysgenesis and TRS. RESULTS Thirteen children carried heterozygous missense pathogenic variants involving the RNA helicase DHX37, which is essential for ribosome biogenesis. Enrichment of rare/novel DHX37 missense variants in 46,XY DSD is highly significant compared with controls (P value = 5.8 × 10-10). Five variants are de novo (P value = 1.5 × 10-5). Twelve variants are clustered in two highly conserved functional domains and were specifically associated with gonadal dysgenesis and TRS. Consistent with a role in early testis development, DHX37 is expressed specifically in somatic cells of the developing human and mouse testis. CONCLUSION DHX37 pathogenic variants are a new cause of an autosomal dominant form of 46,XY DSD, including gonadal dysgenesis and TRS, showing that these conditions are part of a clinical spectrum. This raises the possibility that some forms of DSD may be a ribosomopathy.
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Affiliation(s)
- Ken McElreavey
- Human Developmental Genetics Unit, Institut Pasteur, Paris, France.
| | - Anne Jorgensen
- Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
| | - Caroline Eozenou
- Human Developmental Genetics Unit, Institut Pasteur, Paris, France
| | - Tiphanie Merel
- Human Developmental Genetics Unit, Institut Pasteur, Paris, France
| | | | - Daisylyn Senna Tan
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Federica Buonocore
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, UCL, London, UK
| | - Nick Warr
- Mammalian Genetics Unit, Medical Research Council Harwell Institute, Oxfordshire, UK
| | - Raissa G G Kay
- Mammalian Genetics Unit, Medical Research Council Harwell Institute, Oxfordshire, UK
| | - Matthieu Peycelon
- AP-HP, Hôpital d'Enfants Armand-Trousseau, Genetics and Embryology Department; Sorbonne Université; INSERM UMRS_933, Paris, France
- AP-HP, Hôpital Universitaire Robert-Debré, Pediatric Urology Department,; Reference Center for Rare Diseases (CRMR) Malformations Rares des Voies Urinaires (MARVU), Université de Paris, Paris, France
- Riley Children Hospital, Pediatric Urology Department; Indiana University, School of Medicine, Indianapolis, USA
| | - Jean-Pierre Siffroi
- AP-HP, Hôpital d'Enfants Armand-Trousseau, Genetics and Embryology Department; Sorbonne Université; INSERM UMRS_933, Paris, France
| | - Inas Mazen
- Genetics Department, National Research Center, Cairo, Egypt
| | - John C Achermann
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, UCL, London, UK
| | | | - Juliane Leger
- Endocrinology et Diabetic Pediatrics, Hospital Robert Debre, Paris, France
| | - Agnes Sallai
- Second Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Jean-Claude Carel
- Endocrinology et Diabetic Pediatrics, Hospital Robert Debre, Paris, France
| | | | - Romain Le Ru
- Department of Pathology, University Hospital, University of Franche-Comté, Besançon, France
| | - Gerard S Conway
- Reproductive Medicine Unit, Institute for Women's Health UCL, London, UK
| | - Brigitte Mignot
- Department of Pediatrics, University Hospital, University of Franche-Comté, Besançon, France
| | - Lionel Van Maldergem
- Human Genetics Center, University Hospital, University of Franche-Comté, Besançon, France
| | - Rita Bertalan
- First Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Evgenia Globa
- Ukrainian Center of Endocrine Surgery Endocrine Organs and Tissue Transplantation, MoH of Ukraine, Kyiv, Ukraine
| | - Raja Brauner
- Fondation Ophtalmologique Adolphe de Rothschild and Université Paris Descartes, Paris, France
| | - Ralf Jauch
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Serge Nef
- Department of Genetic Medicine and Development University of Geneva, Geneva, Switzerland
| | - Andy Greenfield
- Mammalian Genetics Unit, Medical Research Council Harwell Institute, Oxfordshire, UK
| | - Anu Bashamboo
- Human Developmental Genetics Unit, Institut Pasteur, Paris, France.
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Hughes LA, McKay-Bounford K, Webb EA, Dasani P, Clokie S, Chandran H, McCarthy L, Mohamed Z, Kirk JMW, Krone NP, Allen S, Cole TRP. Next generation sequencing (NGS) to improve the diagnosis and management of patients with disorders of sex development (DSD). Endocr Connect 2019; 8:100-110. [PMID: 30668521 PMCID: PMC6373624 DOI: 10.1530/ec-18-0376] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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] [Received: 12/07/2018] [Accepted: 01/16/2019] [Indexed: 11/08/2022]
Abstract
Disorders of sex development (DSDs) are a diverse group of conditions where the chromosomal, gonadal or anatomical sex can be atypical. The highly heterogeneous nature of this group of conditions often makes determining a genetic diagnosis challenging. Prior to next generation sequencing (NGS) technologies, genetic diagnostic tests were only available for a few of the many DSD-associated genes, which consequently had to be tested sequentially. Genetic testing is key in establishing the diagnosis, allowing for personalised management of these patients. Pinpointing the molecular cause of a patient's DSD can significantly impact patient management by informing future development needs, altering management strategies and identifying correct inheritance pattern when counselling family members. We have developed a 30-gene NGS panel, designed to be used as a frontline test for all suspected cases of DSD (both 46,XX and 46,XY cases). We have confirmed a diagnosis in 25 of the 80 patients tested to date. Confirmed diagnoses were linked to mutations in AMH, AMHR2, AR, HSD17B3, HSD3B2, MAMLD1, NR5A1, SRD5A2 and WT1 which have resulted in changes to patient management. The minimum diagnostic yield for patients with 46,XY DSD is 25/73. In 34/80 patients, only benign or likely benign variants were identified, and in 21/80 patients only variants of uncertain significance (VOUS) were identified, resulting in a diagnosis not being confirmed in these individuals. Our data support previous studies that an NGS panel approach is a clinically useful and cost-effective frontline test for patients with DSDs.
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Affiliation(s)
- L A Hughes
- West Midlands Regional Genetics Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - K McKay-Bounford
- West Midlands Regional Genetics Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - E A Webb
- Department of Endocrinology & Diabetes, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - P Dasani
- West Midlands Regional Genetics Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - S Clokie
- West Midlands Regional Genetics Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - H Chandran
- Department of Endocrinology & Diabetes, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - L McCarthy
- Department of Endocrinology & Diabetes, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Z Mohamed
- Department of Endocrinology & Diabetes, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - J M W Kirk
- Department of Endocrinology & Diabetes, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - N P Krone
- Department of Endocrinology & Diabetes, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - S Allen
- West Midlands Regional Genetics Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - T R P Cole
- West Midlands Regional Genetics Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
- Correspondence should be addressed to T R P Cole:
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7
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Abstract
Surgical management of disorders of sex development (DSD) is associated with contentious debate between and within stakeholder communities. While the intent of surgical management of the genitals and gonads is to benefit the patient physically and psychosocially, these goals have not always been achieved; reports of harm have surfaced. Harm experienced by some patients has resulted in the emergence of an activist platform calling for a moratorium on all surgical procedures during childhood-excepting those forestalling threats to life within the childhood years. This ban is not universally endorsed by patient advocacy groups. Parents, meanwhile, continue to need to make decisions regarding surgical options for their young children. Constructive paths forward include implementation of Consensus Statement recommendations that call for comprehensive and integrated team care, incorporating mental health services, and adopting shared decision making.
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Affiliation(s)
| | - David E. Sandberg
- Division of Pediatric Psychology and the Child Health Evaluation and Research (CHEAR) Center, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, United States
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Tica SS, Eugster EA. How often are clinicians performing genital exams in children with disorders of sex development? J Pediatr Endocrinol Metab 2017; 30:1281-1284. [PMID: 29176024 DOI: 10.1515/jpem-2017-0055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 10/02/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND We sought to determine the frequency with which genital exams (GEs) are performed in children with disorders of sex development (DSD) and ambiguous genitalia (AG) during routine visits to the pediatric endocrine clinic. METHODS Medical records of children with DSD and AG seen at one large academic center since 2007 were reviewed. Data analyzed included diagnosis, sex of rearing, age, initial or follow up visit, number of individuals present and sex of the pediatric endocrinologist. Repeated measures analysis was performed to evaluate associations between GEs and patient/physician factors. RESULTS Eighty-two children with DSD and AG who had a total of 632 visits were identified. Sex of rearing was female in 78% and the most common diagnosis was congenital adrenal hyperplasia (CAH) (68%). GEs were performed in 35.6% of visits. GEs were more likely in patients with male sex of rearing (odds ratio [OR] 17.81, p=0.006), during initial vs. follow-up visits (OR 5.99, p=0.012), and when the examining endocrinologist was female (OR 3.71, p=0.014). As patients aged, GEs were less likely (OR 0.76, p<0.0001). CONCLUSIONS GEs were performed in approximately one-third of clinic visits in children with DSD and AG. Male sex of rearing, initial visits and female pediatric endocrinologist were associated with more frequent GEs.
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Abstract
Among the most defining events of an individual's life, is the development of a human embryo into male or a female. The phenotypic sex of an individual depends on the type of gonad that develops in the embryo, a process which itself is determined by the genetic setting of the individual. The development of the gonads is different from any other organ, as they possess the potential to differentiate into two functionally distinct organs, testes, or ovaries. Sex development can be divided into two distinctive processes, "sex determination," which is the commitment of the undifferentiated gonad into either a testis or an ovary, a process that is genetically programmed in a critically timed manner and "sex differentiation," which takes place through hormones produced by the gonads, once the developmental sex determination decision has been made. Disruption of any of the genes involved in either the testicular or ovarian development pathway could lead to disorders of sex development. In this review, we provide an insight into the factors important for sex determination, their antagonistic actions and whenever possible, references on the "prismatic" clinical cases are given. Birth Defects Research (Part C) 108:365-379, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Wassim Eid
- Division of Endocrinology, Department of Medicine, University of Fribourg, Fribourg, Switzerland.,Department of Biochemistry, Medical Research Institute, University of Alexandria, Alexandria, Egypt
| | - Anna Biason-Lauber
- Division of Endocrinology, Department of Medicine, University of Fribourg, Fribourg, Switzerland
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10
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King TFJ, Wat WZM, Creighton SM, Conway GS. Bone mineral density in complete androgen insensitivity syndrome and the timing of gonadectomy. Clin Endocrinol (Oxf) 2017; 87:136-140. [PMID: 28493277 DOI: 10.1111/cen.13368] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/01/2017] [Accepted: 05/05/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Low bone mineral density (BMD) has been reported in complete androgen insensitivity syndrome (CAIS), but the impact of timing of gonadectomy is not known. We aimed to assess the relationship between age of gonadectomy and BMD in women with CAIS. DESIGN Retrospective analysis of pre- and post-gonadectomy parameters in women with CAIS attending an adult Disorders of Sex Development (DSD) clinic in a tertiary centre. PATIENTS One hundred and thirteen women with CAIS. MEASUREMENTS Dual-energy X-ray absorptiometry (DXA) before and after gonadectomy; and pre-gonadectomy hormone profile. RESULTS Mean BMD was reduced (95% confidence interval); T-score -1.34 (-1.55 to -1.13; P<.001) at the lumbar spine and -0.3 (-0.49 to -0.12; P=.001) at the hip. There was no relationship between age of gonadectomy and BMD. Thirty-two subjects had BMD measured before or within 2 years of gonadectomy, and mean BMD was reduced (95% CI) at the lumbar spine; T-score: -1.05 (-1.54 to -0.57; P<.001), but was normal at the hip; T-score -0.04 (-0.35 to 0.28; P=.8). There was no relationship between BMD and history of hernia, testosterone, oestradiol or follicle stimulating hormone levels. Twelve subjects had DXA both before and after gonadectomy, and after 4.3 (1.7-12.8) years, there was no change in BMD. CONCLUSIONS We found reduced BMD at the spine and hip in subjects with CAIS. We found no relationship between age of gonadectomy and BMD, and we also found no drop in BMD in subjects followed up after gonadectomy.
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Affiliation(s)
- Thomas F J King
- Institute for Women's Health, University College London Hospitals, London, UK
| | - Winnie Z M Wat
- Institute for Women's Health, University College London Hospitals, London, UK
| | - Sarah M Creighton
- Institute for Women's Health, University College London Hospitals, London, UK
| | - Gerard S Conway
- Institute for Women's Health, University College London Hospitals, London, UK
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11
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Abstract
The birth of a child with a disorder of sex development (DSD) prompts a long-term management strategy that involves a myriad of professionals working with the family. There has been progress in diagnosis, surgical techniques and in understanding psychosocial issues related to this condition. However, since these kinds of disorders are rare and have many anatomical variations, individual care is necessary, especially regarding surgical management. Gonadectomy is indicated in a number of intersex disorders with a Y chromosome to reduce the associated risk of cancer. Recently, laparoscopy has gained wide acceptance in pediatric urology. Laparoscopy is also reported to be a useful tool for diagnosing and treating DSD because of its minimal invasiveness and favorable cosmetic outcome. However, reports of evaluation and management using laparoscopy for large numbers of DSD patients are limited and debate is still open about indications and timing of gonadectomy. In this study, we reviewed the literature of the last 10 years about the role of laparoscopic gonadectomy in patients with DSD. In the analyzed papers, all the procedures were accomplished successfully using laparoscopy. No conversions to open surgery neither intra-operative complications were reported in all series. Post-operative complications were reported only in one series and included 1 umbilical port infection [2% (1/50)] and 1 pelvic abscess [2% (1/50)], both treated with antibiotic therapy (grade I Clavien-Dindo). Of the analyzed series, 7/10 reported postoperative diagnosis of gonadal tumors. The histopathologic examinations revealed 15 cases of gonadoblastoma, 7 cases of dysgerminoma and 2 cases of seminoma. Analyzing the single series, the incidence of these tumors varied between 10% and 33%. The results of our review confirmed the safety and efficacy of laparoscopic gonadectomy in DSD patients. In our mind, laparoscopic gonadectomy should be accepted as the treatment of choice in children and adolescents with these rare conditions. It thereby eliminates the risk of malignancies of gonadal origin with the advantages of a minimally invasive procedure, with lower morbidity, quicker postoperative recovery and excellent cosmetic results.
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Affiliation(s)
- Andres Calvo
- Department of Pediatric Surgery, Pediatric Children Hospital, Cordoba, Argentina
| | - Maria Escolino
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Alessandro Settimi
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Agnese Roberti
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Maria Grazia Caprio
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Ciro Esposito
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
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12
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Abstract
Next Generation Sequencing is revolutionising our understanding of variation in the human genome and as costs reduce the sequencing of patient's genomes is become more routine. Areas covered: Here, we review the current challenges in the field and some of the efforts that are underway to resolve them. We describe how these technologies are impacting on our understanding of human sex development and the profound clinical implications of these technologies on conditions such as Disorders of Sex Development (DSD). Expert commentary: The sheer wealth of genomic data is generating new challenges-some are technical such as variant calling, or predicting the functional consequence of a variant-whereas others are more profound, such as establishing the link between extensive genomic information and the clinical presentation. Predicting disease phenotypes from genetic sequences is often extremely difficult because the genotype-phenotype relationship has proven to be far more complex than anticipated.
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Affiliation(s)
- Anu Bashamboo
- a Human Developmental Genetics , Institut Pasteur , Paris , France
| | - Ken McElreavey
- a Human Developmental Genetics , Institut Pasteur , Paris , France
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13
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Warr N, Siggers P, Carré GA, Wells S, Greenfield A. Genetic Analyses Reveal Functions for MAP2K3 and MAP2K6 in Mouse Testis Determination. Biol Reprod 2016; 94:103. [PMID: 27009039 PMCID: PMC5842889 DOI: 10.1095/biolreprod.115.138057] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 12/22/2015] [Accepted: 03/08/2016] [Indexed: 01/27/2023] Open
Abstract
Testis determination in mammals is initiated by expression of SRY in somatic cells of the embryonic gonad. Genetic analyses in the mouse have revealed a requirement for mitogen-activated protein kinase (MAPK) signaling in testis determination: targeted loss of the kinases MAP3K4 and p38 MAPK causes complete XY embryonic gonadal sex reversal. These kinases occupy positions at the top and bottom level, respectively, in the canonical threetier MAPK-signaling cascade: MAP3K, MAP2K, MAPK. To date, no role in sex determination has been attributed to a MAP2K, although such a function is predicted to exist. Here, we report roles for the kinases MAP2K3 and MAP2K6 in testis determination. C57BL/6J (B6) embryos lacking MAP2K3 exhibited no significant abnormalities of testis development, whilst those lacking MAP2K6 exhibited a minor delay in testis determination. Compound mutants lacking three out of four functional alleles at the two loci also exhibited delayed testis determination and transient ovotestis formation as a consequence, suggestive of partially redundant roles for these kinases in testis determination. Early lethality of double-knockout embryos precludes analysis of sexual development. To reveal their roles in testis determination more clearly, we generated Map2k mutant B6 embryos using a weaker Sry allele (SryAKR). Loss of Map2k3 on this highly sensitized background exacerbates ovotestis development, whilst loss of Map2k6 results in complete XY gonadal sex reversal associated with reduction of Sry expression at 11.25 days postcoitum. Our data suggest that MAP2K6 functions in mouse testis determination, via positive effects on Sry, and also indicate a minor role for MAP2K3.
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Affiliation(s)
- Nick Warr
- Mammalian Genetics Unit, Medical Research Council, Harwell, Oxfordshire, United Kingdom
| | - Pam Siggers
- Mammalian Genetics Unit, Medical Research Council, Harwell, Oxfordshire, United Kingdom
| | - Gwenn-Aël Carré
- Mammalian Genetics Unit, Medical Research Council, Harwell, Oxfordshire, United Kingdom
| | - Sara Wells
- The Mary Lyon Centre, Medical Research Council, Harwell, Oxfordshire, United Kingdom
| | - Andy Greenfield
- Mammalian Genetics Unit, Medical Research Council, Harwell, Oxfordshire, United Kingdom
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14
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Ben Hadj Hmida I, Mougou-Zerelli S, Hadded A, Dimassi S, Kammoun M, Bignon-Topalovic J, Bibi M, Saad A, Bashamboo A, McElreavey K. Novel homozygous nonsense mutations in the luteinizing hormone receptor (LHCGR) gene associated with 46,XY primary amenorrhea. Fertil Steril 2016; 106:225-229.e11. [PMID: 27016457 DOI: 10.1016/j.fertnstert.2016.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 08/31/2015] [Revised: 02/24/2016] [Accepted: 03/03/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine the genetic cause of 46,XY primary amenorrhea in three 46,XY girls. DESIGN Whole exome sequencing. SETTING University cytogenetics center. PATIENT(S) Three patients with unexplained 46,XY primary amenorrhea were included in the study. INTERVENTION(S) Potentially pathogenic variants were confirmed by Sanger sequencing, and familial segregation was determined where parents' DNA was available. MAIN OUTCOME MEASURE(S) Exome sequencing was performed in the three patients, and the data were analyzed for potentially pathogenic mutations. The functional consequences of mutations were predicted. RESULT(S) Three novel homozygous nonsense mutations in the luteinizing hormone receptor (LHCGR) gene were identified:c.1573 C→T, p.Gln525Ter, c.1435 C→T p.Arg479Ter, and c.508 C→T, p.Gln170Ter. CONCLUSION(S) Inactivating mutations of the LHCGR gene may be a more common cause of 46,XY primary amenorrhea than previously considered.
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Affiliation(s)
- Imen Ben Hadj Hmida
- Laboratory of Human Cytogenetics, Molecular Genetics and Reproductive Biology, Farhat Hached University Hospital, Sousse, Tunisia; Human Developmental Genetics, Institut Pasteur, Paris, France
| | - Soumaya Mougou-Zerelli
- Laboratory of Human Cytogenetics, Molecular Genetics and Reproductive Biology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Anis Hadded
- Department of Gynecology and Obstetrics, Farhat Hached University Hospital, Sousse, Tunisia
| | - Sarra Dimassi
- Laboratory of Human Cytogenetics, Molecular Genetics and Reproductive Biology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Molka Kammoun
- Laboratory of Human Cytogenetics, Molecular Genetics and Reproductive Biology, Farhat Hached University Hospital, Sousse, Tunisia
| | | | - Mohamed Bibi
- Department of Gynecology and Obstetrics, Fattouma Bourguiba Teaching Hospital, Monastir, Tunisia
| | - Ali Saad
- Laboratory of Human Cytogenetics, Molecular Genetics and Reproductive Biology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Anu Bashamboo
- Human Developmental Genetics, Institut Pasteur, Paris, France
| | - Ken McElreavey
- Human Developmental Genetics, Institut Pasteur, Paris, France.
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15
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Byne W. LGBT Health: Going Strong as We Begin Our Second Year. LGBT Health 2016; 2:1-2. [PMID: 26790010 DOI: 10.1089/lgbt.2015.0010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- William Byne
- Department of Psychiatry, Icahn School of Medicine and James J. Peters VA Medical Center, Bronx, New York
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16
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Reiner W, Byne W. Interview with William Reiner, MD, Urologist and Child Psychiatrist, on Approaches to Care for Individuals with Disorders of Sex Development and Somatic Intersex Conditions. LGBT Health 2016; 2:3-10. [PMID: 26790011 DOI: 10.1089/lgbt.2015.0008] [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] [Indexed: 10/22/2022] Open
Affiliation(s)
- William Reiner
- 2 Department of Pediatric Urology, Pediatric Urology, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - William Byne
- 1 Department of Psychiatry, Icahn School of Medicine and James J. Peters VA Medical Center, Bronx, New York
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17
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Abstract
Congenital disruptions of sex hormone production lead to wide-ranging developmental and physiological effects in individuals who have atypical chromosomal, gonadal or anatomic sex. Aberrant developmental sex hormone exposure causes disorders of genital anatomy, attainment of secondary sexual characteristics and has long-term effects on metabolism, fertility and psychological functioning. Principles in the management of disorders of sex development (DSD) aim to improve physiological health and long-term outcome, as well as development of male or female sexual anatomy. Concerns raised by DSD patient advocacy groups about beneficence and autonomy with respect to prescribed hormone treatments and avoidance of unnecessary genital and gonadal surgery have demanded greater informed consent and attention to long-term outcome. Hormone treatment is influenced by underlying clinical diagnosis and by factors such as sex of rearing and gender identity of the affected individual. We describe diagnostic criteria for different DSDs, clinical considerations in management protocols, together with current concepts and detailed practical hormone treatments for male and female individuals with DSD. Gender identity issues requiring multidisciplinary consensus, ethical consideration and informed consent or assent from the young person are also addressed.
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Affiliation(s)
- Jacqueline Hewitt
- Department of Endocrinology, Royal Children's Hospital, 3 West Clinical Offices, 50 Flemington Road, Parkville, Victoria 3052, Australia.
| | - Margaret Zacharin
- Department of Endocrinology, Royal Children's Hospital, 3 West Clinical Offices, 50 Flemington Road, Parkville, Victoria 3052, Australia
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