Prevalence of endocrine and genetic abnormalities in boys evaluated systematically for a disorder of sex development
Open Access
- 30 August 2017
- journal article
- research article
- Published by Oxford University Press (OUP) in Human Reproduction
- Vol. 32 (10), 2130-2137
- https://doi.org/10.1093/humrep/dex280
Abstract
What is the likelihood of identifying genetic or endocrine abnormalities in a group of boys with 46, XY who present to a specialist clinic with a suspected disorder of sex development (DSD)? An endocrine abnormality of the gonadal axis may be present in a quarter of cases and copy number variants (CNVs) or single gene variants may be present in about half of the cases. Evaluation of 46, XY DSD requires a combination of endocrine and genetic tests but the prevalence of these abnormalities in a sufficiently large group of boys presenting to one specialist multidisciplinary service is unclear. This study was a retrospective review of investigations performed on 122 boys. All boys who attended the Glasgow DSD clinic, between 2010 and 2015 were included in the study. The median external masculinization score (EMS) of this group was 9 (range 1–11). Details of phenotype, endocrine and genetic investigations were obtained from case records. An endocrine abnormality of gonadal function was present in 28 (23%) with a median EMS of 8.3 (1–10.5) whilst the median EMS of boys with normal endocrine investigations was 9 (1.5–11) (P = 0.03). Endocrine abnormalities included a disorder of gonadal development in 19 (16%), LH deficiency in 5 (4%) and a disorder of androgen synthesis in 4 (3%) boys. Of 43 cases who had array-comparative genomic hybridization (array-CGH), CNVs were reported in 13 (30%) with a median EMS of 8.5 (1.5–11). Candidate gene analysis using a limited seven-gene panel in 64 boys identified variants in 9 (14%) with a median EMS of 8 (1–9). Of the 21 boys with a genetic abnormality, 11 (52%) had normal endocrine investigations. A selection bias for performing array-CGH in cases with multiple congenital malformations may have led to a high yield of CNVs. It is also possible that the yield of single gene variants may have been higher than reported if the investigators had used a more extended gene panel. The lack of a clear association between the extent of under-masculinization and presence of endocrine and genetic abnormalities suggests a role for parallel endocrine and genetic investigations in cases of suspected XY DSD. RN was supported by the James Paterson Bursary and the Glasgow Children's Hospital Charity Summer Scholarship. SFA, RM and EST are supported by a Scottish Executive Health Department grant 74250/1 for the Scottish Genomes Partnership. EST is also supported by MRC/EPSRC Molecular Pathology Node and Wellcome Trust ISSF funding. There are no conflicts of interest. None.Keywords
Funding Information
- James Paterson Bursary
- Glasgow Children's Hospital Charity Summer Scholarship
- Scottish Executive Health Department (74250/1)
- MRC/EPSRC Molecular Pathology Node
- Wellcome Trust ISSF funding
This publication has 29 references indexed in Scilit:
- Understanding the genetic aetiology in patients with XY DSDBritish Medical Bulletin, 2013
- Factors That Influence the Decision to Perform a Karyotype in Suspected Disorders of Sex Development: Lessons from the Scottish Genital Anomaly Network RegisterSexual Development, 2011
- Identification of De Novo Copy Number Variants Associated with Human Disorders of Sexual DevelopmentPLOS ONE, 2010
- Investigation and initial management of ambiguous genitaliaBest Practice & Research Clinical Endocrinology & Metabolism, 2010
- Prolonged human chorionic gonadotrophin stimulation as a tool for investigating and managing undescended testesClinical Endocrinology, 2007
- Consensus statement on management of intersex disordersArchives of Disease in Childhood, 2005
- ETIOLOGICAL STUDIES OF SEVERE OR FAMILIAL HYPOSPADIASJournal of Urology, 2001
- The testosterone:androstenedione ratio in male undermasculinizationClinical Endocrinology, 2000
- Pituitary-gonadal axis in male undermasculinisationArchives of Disease in Childhood, 2000
- Assessment of the gonadotrophin-gonadal axis in androgen insensitivity syndromeArchives of Disease in Childhood, 1999