Clinical, genetic, and pathological analysis in 165 children with disorders of sex development / 中国当代儿科杂志

OBJECTIVES@#To investigate the clinical phenotypes, genetic characteristics, and pathological features of children with disorders of sex development (DSD).@*METHODS@#A retrospective analysis was conducted on epidemiological, clinical phenotype, chromosomal karyotype, gonadal pathology, and genotype data of 165 hospitalized children with DSD at Children's Hospital of Hebei Province and Tangshan Maternal and Child Health Hospital from August 2008 to December 2022.@*RESULTS@#Among the 165 children with DSD, common presenting symptoms were short stature (62/165, 37.6%), clitoromegaly (33/165, 20.0%), cryptorchidism (28/165, 17.0%), hypospadias (24/165, 14.5%), and skin pigmentation abnormalities/exteriorized pigmented labia majora (19/165, 11.5%). Chromosomal karyotype analysis was performed on 127 cases, revealing 36 cases (28.3%) of 46,XX DSD, 34 cases (26.8%) of 46,XY DSD, and 57 cases (44.9%) of sex chromosome abnormalities. Among the sex chromosome abnormal karyotypes, the 45,X karyotype (11/57, 19%) and 45,X/other karyotype mosaicism (36/57, 63%) were more common. Sixteen children underwent histopathological biopsy of gonadal tissues, resulting in retrieval of 25 gonadal tissues. The gonadal tissue biopsies revealed 3 cases of testes, 3 cases of dysplastic testes, 6 cases of ovaries, 11 cases of ovotestes, and 1 case each of streak gonad and agenesis of gonads. Genetic testing identified pathogenic/likely pathogenic variants in 23 cases (23/36, 64%), including 12 cases of 21-hydroxylase deficiency congenital adrenal hyperplasia caused by CYP21A2 pathogenic variants.@*CONCLUSIONS@#Short stature, clitoromegaly, cryptorchidism, hypospadias, and skin pigmentation abnormalities are common phenotypes in children with DSD. 45,X/other karyotype mosaicism and CYP21A2 compound heterozygous variants are major etiological factors in children with DSD. The most commonly observed gonadal histopathology in children with DSD includes ovotestes, ovaries, and testes/dysgenetic testes.

Uso da FISH em mucosa oral para investigação de mosaicismo com linhagem 45,X: estudo com homens saudáveis e pacientes com distúrbios da diferenciação do sexo / The use of FISH on buccal smear to investigate mosaicism with a 45,X cell line: study on healthy men and patients with disorders of sex development

Objetivo: Verificar se a hibridização in situ por fluorescência (FISH) em células de mucosa oral poderia ser empregada para detectar criptomosaicismo com linhagem 45,X em pacientes 46,XY. Sujeitos e métodos: Amostra de 19 jovens saudáveis 46,XY e cinco pacientes com distúrbios da diferenciação do sexo (DDS), quatro 45,X/46,XY e um 46,XY. FISH com sondas específicas para X e Y em núcleos interfásicos de linfócitos e mucosa oral para investigar a proporção de núcleos contendo apenas o sinal do cromossomo X. Resultados: A frequência de núcleos contendo apenas o sinal do X nos dois tecidos dos homens saudáveis não diferiu (p = 0,69). Em todos os pacientes com DDS essa frequência foi significativamente maior, e também não houve diferença entre os dois tecidos (p = 0,38). Conclusões: A investigação de mosaicismo com linhagem 45,X em pacientes com DDS 46,XY ou esterilidade pode ser feita por FISH diretamente em células de mucosa oral. .

Objective: To verify whether fluorescence in situ hybridization (FISH) of cells from the buccal epithelium could be employed to detect cryptomosaicism with a 45,X lineage in 46,XY patients. Subjects and methods: Samples of nineteen 46,XY healthy young men and five patients with disorders of sex development (DSD), four 45,X/46,XY and one 46,XY were used. FISH analysis with X and Y specific probes on interphase nuclei from blood lymphocytes and buccal epithelium were analyzed to investigate the proportion of nuclei containing only the signal of the X chromosome. Results: The frequency of nuclei containing only the X signal in the two tissues of healthy men did not differ (p = 0.69). In all patients with DSD this frequency was significantly higher, and there was no difference between the two tissues (p = 0.38), either. Conclusions: Investigation of mosaicism with a 45,X cell line in patients with 46,XY DSD or sterility can be done by FISH directly using cells from the buccal epithelium. .

Ambiguous genitalia: two decades of experience

Ambiguous genitalia is a complex, medical and social emergency. The aim of this study is to present our experience over two decades, focusing on the pattern and clinical presentation. A retrospective study conducted in the pediatric endocrine clinic at a university hospital in Saudi Arabia during the period 1989-2008. Medical records of children with ambiguous genitalia were reviewed and the genitalia described. Of the 81 children with ambiguous genitalia, 53 [65.4%] patients were genetically females [46XY], with congenital adrenal hyperplasia being the common cause in 51 [96.5%] patients. Hyperpigmentation, variable degrees of salt wasting and a family history of a similar problem helped in diagnosis. Male genetic sex [46XY] was present in only 28 [34.6%] patients with a diversity of causes; multiple congenital anomalies in 9 [32.1%], local anorectal anomalies in 2 [7.1%], congenital adrenal hyperplasia [3-[beta-hydroxysteroid dehydrogenase deficiency] in 2 [7.14%], 5-alpha-reductase deficiency in 4 [14.28%], partial androgen insensitivity in 3 [10.7%], complete androgen insensitivity in 4 [14.28%], and hypogonadotrophin deficiency in 4 [14.3%]. Twenty-five [47.2%] of females were wrongly assigned as males, where only two [7.1%] males were wrongly assigned as females. Ambiguous genitalia, currently termed disorders of sex development [DSD], is not uncommon in our community. Increased awareness, a detailed history, and a careful physical examination, coupled with appropriate laboratory and radiological investigations aid in early diagnosis and avoid serious sequelae

Intersexuality in a crab-eating fox (cerdocyon thous) / Intersexualidade em uma raposa (cerdocyon thous)

Intersexuality is a reproductive pathology that has been described in wild animals in recent years. However, its occurrence and consequences remain obscure and therefore all aspects of this reproductive disorder deserve attention. The aim of this study is to report a case of intersexuality with probable absence of gonadal tissue in the crab-eating fox (Cerdocyon thous) native to Brazil. The animal has male external genitalia, but its prepuce and penis were both hypoplastic. Because of a clinical suspicion of bilateral cryptorchidism, a laparotomy was performed and the absence of prostate and gonads were revealed. The procedure also revealed vas deferentia, extending laterally from the each side of the bladder basis to the right and left abdominal wall muscles. The animal died one month later, and post mortem examination confirmed the absence of prostatic and gonadal tissues. Muscular structures similar to uterine horns and cervix were founded macroscopically and confirmed by optic microscopy. In addition, post mortem findings corroborate with penis hypoplasia, since penile bone presence was observed. The vasa deferentia had a normal tissue structure, although hypoplastic. In conclusion, the case of a crab-eating fox (Cerdocyon thous) reported here represents a proved intersexual animal with probable absence of gonadal tissue.

A intersexualidade é uma das patologias reprodutivas, hereditária e/ou congênita, que têm sido mais reportada em animais selvagens nos últimos anos. Entretanto, suas ocorrências e conseqüências permanecem obscuras, sendo que todos os aspectos relacionados a este distúrbio reprodutivo merecem atenção. O objetivo deste estudo foi relatar um caso de intersexualidade com provável ausência de tecido gonadal em uma raposa (Cerdocyon thous) do Brasil. O animal apresentava sexo fenotípico masculino, mas seu prepúcio e pênis eram pequenos. Devido a uma suspeita clínica de criptorquidismo bilateral, foi realizada uma laparotomia, sendo, no procedimento cirúrgico, revelada a ausência de próstata e gônadas. Os ductos deferentes foram localizados lateralmente à bexiga, entendendo-se desde a sua base, inserindo-se na musculatura da parede abdominal direita e esquerda. Um mês após, o animal morreu e os achados necroscópicos confirmaram a ausência de tecidos prostático e gonadal. Entretanto, uma estrutura muscular histologicamente semelhante a cornos e cérvix uterinos foram encontradas. Além disso, pelo mesmo método, ratificou-se a ausência de próstata e o pênis exibiu aspecto normal contendo osso peniano. Os ductos deferentes apresentaram estrutura tecidual normal, porém hipoplásicos. Concluiu-se que o caso reportado no presente trabalho representa um exemplo de intersexualidade com provável ausência de tecido gonadal em um animal da espécie Cerdocyon thous.

Hermaphroditism: cytogenetics, gonadal pathology and gender assignment: a case report / Hermafroditismo: citogenética, patología gonadal y asignación de género

True hermaphroditism is a rare intersex disorder in which individuals possess both testicular and ovarian gonadal tissue. A case of true unilateral hermaphroditism presenting with ambiguous external genitalia, right scrotal testis and left pelvic ovotestis is herein outlined Phallic, gonadal and genetic factors were considered before male gender was assigned. Gender assignment procedures have been questioned by intersex activists opposed to early genital surgery. Western societies have a binary perspective on gender and this leads to a stigma being placed on intersex cases. A multidisciplinary approach to this problem involving paediatric specialists in the field, of endocrinology, surgery and psychiatry is necessary, along with educational programmes that promote tolerance in society to variations in gender.

A hermaphrodite dog with bilateral ovotestes and pyometra

Hermaphroditism was identified in a 3-year-old American Cocker spaniel with an enlarged os clitoridis that was shown as reddish finger-like structure protruding from the vulva. The urethral orifice was located cranially to the base of the os clitoridis. The gonads were situated caudal to the kidneys at the cranial tips of the uterine horns, and were composed mainly of seminiferous tubules and interstitial cells and had ovarian follicles in the cortices. The uterus was enlarged and revealed pyometra. Gross and histopathological findings of the dog suggested hermaphroditism with bilateral ovotestes and pyometra.

Anatomical study on true hermaphroditism in an Indian pig (Sus Scrofa Domesticus)

A pig was confirmed to be a true hermaphrodite on the basis of gross and histomorphological studies of the genital organs. The genitalia was consisted of left ovary, oviduct, two coiled uterine horns, body of uterus alongwith right testis and an epididymis. Vagina and vulva were absent but male urethra with prostate gland was present. Grossly the size of all the genital organs appeared to be normal. Histomorphologically, testis and epididymis were underdeveloped as there was no clearcut spermatogenia and sertoli cells but Leydig cells were normal. The ovary presents normal histological features with some portion of testicular tissue. Degeneration of uterine epithelium was observed along with normal endometrial glands.

Pseudohermafroditismo masculino interno: a propósito de seis casos / Pseudohermaphroditism male internal: a purpose of cases six

El síndrome de persistencia de estructuras müllerianas en un estado intersexual de pseudohermafroditismo interno, caracterizado por la presencia de genitales internos y externos masculinos, con trompas, y 1/3 superior de vagina rudimentarios ubicados intraabdominalmente o en un saco herniario. Esta anomalia ocurre durante el desarrollo embrionario y se atribuye a falta del factor inhibidor mülleriano (MIF) producido por las células de Sertoli. Este trabajo describe 6 casos de niños con intersexualidad. todos presentaron criptorquidia y un 83 por ciento hernia inguinal; el fenotipo correspondió con el cariotipo (46, XY) y los estudios urológicos fueron normales en un 83 por ciento. Por laparoscopia se visualizaron testículos y rudimentos müllerianos bilaterales. Los hallazgos encontrados corroboran que en este síndrome la presencia de rudimentos müllerianos se debe a falta de acción del MIF y la criptorquidia que la acompaña podría ser consecuencia de un impedimento mecánico sumado a falta de acción del MIF en el descenso testicular

Ambigüedad de genitales I. Abordaje inicial del paciente / Ambigous genitalia. Initial diagnosis approach

Se presentan los criterios para el abordaje diagnóstico inicial de pacientes con alteraciones en la diferenciación sexual, de acuerdo a los lineamientos del Grupo Para el Estudio del Intersexo del Instituto Nacional de Pediatría. Una vez definidas las alteraciones genitales de cada paciente, así como sus antecedentes personales y familiares, se sugiere un protocolo de exámenes paraclínicos indispensables para iniciar el abordaje sindromático. Se hace énfasis en la necesidad de no establecer una asignación sexual social ni funcional hasta no haber esclarecido la etiología precisa del trastorno.

Genitales ambiguos: experiencia en el Hospital Nacional "Guillermo Almenara I." / Ambiguous genitalia: experience in the Guillermo Almenara Irigoyen National Hospital

Durante los años 1988 a 1993 se evaluó a 20 niños portadores de ambiguedad sexual. Se encontró que el 70 por ciento de niños presentaban un cariotipo 46XX, y en estos pacientes el 57 por ciento correspondió a Hiperplasia Adrenal Congénita; en pacientes con cariotipo 46XY, la mayor frecuencia correspondio a Sindrome de Malformacione Multiples. Entre todos los pacientes con genitales ambiguos, la mayor frecuencia correspondió a Hiperplasia Adrenal Congénita, seguido del Sindrome de Malformaciones Multiples y la clitoromegalia

Male pseudohermaphroditism with hypertension due to 17 alpha-hydroxylase deficiency

Um pseudohermafrodita masculino de 14 anos de idade apresentou-se com hipertensäo sistêmica e hipocalemia. Níveis plasmáticos de progesterona, deoxicorticosterona, corticosterona, 18-hidroxicorticosterona e 18-hidroxideoxicorticosterona encontravam-se elevados, enquanto os de cortisol, aldosterona e de andrógenos estavam todos reduzidos. Estímulo com ACTH produziu incrementos adicionais nos níveis dos esteróides já elevados mas näo nos de cortisol, aldosterona e andrógenos. Supressäo aguda e prolongada (1 mês) do ACTH endógeno com dexametasona normalizaram os níveis plasmáticos dos esteróides elevados. Estímulo postural näo elevou significativamente os níveis de aldosterona. Estruturas gonadais removidas durante cirurgia revelaram testículos com espessamento da túnica albugínea e atrofia dos túbulos seminíferos. A terapia de reposiçäo prolongada (6 meses) com glicocorticóides e estrógenos normalizou a pressäo sanguínea e os níveis séricos de potássio, e produziu um desenvolvimento mamário adequado.

Estudios clínicos, citogenéticos, endocrinológicos e histológicos en hermafroditas verdaderos / Clinical, cytogenetic, endocrinologic and histologic studies in true hermaphroditism

En el presente trabajo se describen los hallazgos clínicos, citogenéticos, endocrinológicos e histológicos en nueve pacientes mexicanos con hermafroditismo verdadero. La edad de los pacientes, a su ingreso, se encontraba entre los 10 meses y los 27 años; en siete casos el sexo de asignación era masculino, siendo el cariotipo más frecuente 46,XX (n=6). Las concentraciones basales de gonadotropinas y esteroides gonadales variaron de acuerdo con la edad del sujeto, tipo de gónada y estado funcional de la misma aunque la funcionalidad del tejido ovárico siempre fue superior a la del tejido testicular. La respuesta de testosterona al estímulo con HCG también fue variable. En un sujeto con hematuria cíclica se logró detectar ovulación expontánea. La gónada más frecuentemente encontrada fue el ovotestes siendo bilateral en cuatro casos; los genitales internos variaron dependiendo del tipo de gónada presente; en los nueve casos se documentó la presencia de útero. Los hallazgos previamente descritos concuerdan con lo reportado en individuos con hermafroditismo verdadero en otras poblaciones.

Síndrome de sohval: caso reportado / Sohval syndrome: a case report

Lactante mayor de 7 meses de edad el cual fue referido del interior del país con la impresión diagnóstica de alformaciones congénitas múltiples para estudio. Después de un estudio clínico completo y de los exámenes complementarios pertinentes se le diagnóstico Disgenesia Gonadal Mixta con Cariotipo 45X/46XY (mosaico), además de otras malformaciones congénitas. Dicho lactante fue masculino fenotípicamente con la presencia de testiculo bífido, gonada derecha palpable, hipospadía interescrotal, pene corto e incurvado y con vagina, la cual fue visualizada a través de la radiografía pelviana con contraste y con la urotrocistografía retrógrada. Este es un caso de desarrollo sexual anormal representado por un mosaicismo 45X/46XY con fenotipo anormal