Case Report Veterinarni Medicina, 52, 2007 (2): 74–78

Male pseudohermaphroditism in dogs: three case reports

M.R. Alam1, Y.G. Cho2, S.J. Cho3, J.I. Lee1, H.B. Lee1, H.J. Tae1, I.S. Kim1, N.S. Kim1

1College of Veterinary Medicine, 2Medical School, Chonbuk National University, Jeonju, Republic of Korea 3Family Animal Medical Clinic, Gunsan, Republic of Korea

ABSTRACT: Three Cocker Spaniel dogs, 2–3 months old, weighing 3–4 kg, were presented to the Chonbuk Animal Medical Centre, Chonbuk National University, with anomalies. Physical, radiological, gross, histological, hormonal and cytogenetic studies were performed. Physical examination of the external genitalia revealed that the dogs possessed the vulva with an enlarged protruding from the vulvar juncture and the scrotum with an undescended testis in Case 1 and 2, and both testes remained undescended in Case 3. Hyperoestrogenaemia and low testosterone serum concentrations were found. Laparotomy revealed persistent Mullerian ducts (PMD) in Case 1 and 2, and abdominally located (s) in all the cases. Histological examinations of the revealed inactive seminiferous tubules. Cytogenetic analysis showed 78XY male karyotype in Case 1 and 2, whereas Case 3 showed 79XX karyotype. The congenital defects were diagnosed as male pseudohermaphroditism (MPH) and PMD in Case 1 and 2, and XX sex reversal MPH in Case 3.

Keywords: male pseudohermaphroditism; XX sex reversal; persistent Mullerian duct; dog

Disorders of genital development occur in all rodites possess testes while having mixed or female species of mammals (Cribiu and Chaffaux, 1990; external genitalia. Female pseudohermaphrodites Passello-Legrand and Mowat, 2004; Weng et al., have but phenotypically they have a mas- 2005). The intersex animal is an animal possessing culine appearance (Howard and Bjorling, 1989; Del the characteristics of both sexes. Intersex animals Amo et al., 2001). In , both are also called pseudohermaphrodites or hermaph- testicular and ovarian tissues are present in vari- rodites depending on their gonads (Howard and ous combinations. A testis may be found on one Bjorling, 1989). Hermaphroditism is a condition side in combination with an on the contral- when the subject has ambiguous genitalia with ateral side, an ovotestis only may be present, or a part or all of the genital organs of both sexes an ovotestis may be paired with a testis or ovary. present (Passello-Legrand and Mowat, 2004). True Problems associated with intersex animals are not have the gonadal tissue of both unique to but can be found in animals sexes whereas pseudohermaphrodites possess the with normal chromosomal karyotypes (Svendsen gonads of one sex (according to which they are clas- et al., 1985; Howard and Bjorling, 1989). These de- sified as male or female pseudohermaphrodites), velopmental disorders are caused by abnormalities but the secondary sex characteristics and external of genetic or chromosomal origin, or inappropriate genitalia of the opposite sex. Male pseudohermaph- hormonal or chemical exposure (Passello-Legrand

Supported by the Korea Science and Engineering Foundation (Grant No. R01-2004-000-10459-0) and 2nd Stage Brain Korea (BK) 21 Project in 2006.

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® and Mowat, 2004). This study presents 3 cases of phate (Atropine Sulfate Inj , Dai Han Pharm. Co. male pseudohermaphroditism in dogs that were Ltd., Korea) 0.05 mg/kg, s.c., the anaesthesia was ® investigated by clinical, histological, hormonal and induced using thiopentone sodium (Thionyl Inj , cytogenetical methods. Dai Han Pharm. Co. Ltd., Korea) 25 mg/kg, i.v. and maintained with enflurane and oxygen delivered through a cuffed endotracheal tube. Supportive Case presentation fluid therapy was maintained throughout the pro- ® cedure and cephalexin (Methilexin Inj , Union Three American Cocker Spaniel dogs, 2–3 moths Korea Pharm. Co. Ltd., Korea) 25 mg/kg, i.v. was old, weighing 4–5 kg, were presented (Case 1 on administered at the time of induction. The dogs 16 January 2003, Case 2 on 4 January 2005 and were then placed on dorsal recumbency and the Case 3 on 5 September 2005) to the Chonbuk Animal caudal abdominal and inguinal regions were surgi- Medical Centre, Chonbuk National University, with cally prepared with 7.5% povidone-iodine surgical intersex anomalies. Physical examination of the ex- scrub. Through a pre-scrotal paramedian laparot- ternal genitalia revealed the presence of the vulva omic incision the gonadal and genital tract tissues with an enlarged clitoris protruding out from the were removed. Castration of the intrascrotal testis vulvar juncture (Figures 1, 2 and 3). Palpation of was performed using a standard open orchidec- the scrotum revealed an undescended testis in Case tomy technique. The postoperative treatment was 1 and 2, and both testes remained undescended in given with cephalexin (Methilexin Inj®, Union Case 3. In addition, physical examination in Case 1 Korea Pharm. Co. Ltd., Korea) 25 mg/kg, i.v., every showed generalized seborrhoea, alopecia and hy- 8 hours, for 5 days. perkeratotic lesions on the ventral neck, thorax, The internal genitalia somewhat resembled those abdomen, flanks, vulva, axilla and caudal thighs of the female with testicle(s) instead of ovary. A per- (Figure 1). A skin scraping test showed the presence sistent Mullerian duct was identified (PMD) in Case of mange mites. Male pseudohermaphroditism was 1 and 2, and abdominally located testicle(s) in all a tentative diagnosis. the cases. After a gross examination the gonadal tis- Blood samples were collected for cytogenetic and sues were fixed for a histopathological study in 10% sex hormone analysis. Exploratory laparotomy was buffered formalin and embedded in paraffin. Five performed as a diagnostic and therapeutic proce- μm sections were made and stained with haematox- dure. Before laparotomy, Case 1 was treated with ylin and eosin and the slides were examined under ® ivermectin (Ivomec Inj , MSD Agvet, Holland) a light microscope. The gonads revealed inactive 0.2 mg/kg, s.c., with a repeated dose after 1 week seminiferous tubules and epididymides (Figure 4). for mange. After premedication with atropine sul- The gonads were confirmed as testes. Serum oestra-

Figure 1. Enlarged clitoris protruding out from the vul- va and generalized seborrhoea, alopecia and hyperkera- Figure 2. Enlarged clitoris protruding out from the vul- totic lesions in Case 1 va in Case 2

75 Case Report Veterinarni Medicina, 52, 2007 (2): 74–78

Figure 3. Enlarged clitoris protruding out from the vul- Figure 4. Seminiferous tubules revealed inactive sper- va in Case 3 matogonias, relatively extensive interstitium and loose- ly arranged Sertoli cells in the interstitium, H&E 40× diol 17β and testosterone concentrations were as- on each side), unilateral (ovotestis on one side and sayed using a commercial radioimmunoassay kit testis or ovary on the other) or lateral (testis on one ® (Coat-A-Count, DPC , Los Angeles, USA), which side and ovary on the other). A pseudohermaphro- revealed high oestradiol 17β and low testosterone dite shows a disagreement between phenotypic and levels in all 3 cases. Cytogenetic analysis was car- gonadal sex (Howard and Bjorling, 1989; Del Amo ried out on blood lymphocyte cultures. Heparinized et al., 2001). These individuals have a single type of blood samples were collected for 72 hours in Ham’s germinal tissue, according to which they are male F12 culture medium, supplemented with pokeweed or female pseudohermaphrodites (Kennedy and and 10% foetal calf serum. Slides were made and Miller, 1993). A female pseudohermaphrodite has stained with 5% Giemsa. Thirty metaphase samples ovaries but male external genitalia, and for a male were scored and a karyotype was performed accord- pseudohermaphrodite the reverse is true. These ing to the recommendation of the Committee for were in full agreement with our cases. the Standard Karyotype for the Dog (Switonski et The genital developmental disorders are caused al., 1994). Cytogenetic analysis showed 78XY male by abnormalities of genetic or chromosomal origin, karyotype in Case 1 and 2, whereas Case 3 showed or inappropriate hormonal or chemical exposure. 79XX female karyotype. The congenital defects were During the early embryonic life the is bipo- diagnosed as male pseudohermaphroditism (MPH) tential and capable of developing into either testis with PMD in Case 1 and 2, and XX sex reversal MPH or ovary. The control mechanisms of sexual develop- in Case 3. ment are sequential and normal sexual differentia- tion of the embryo depends on three major events. The chromosomal sex determines the gonadal sex DISCUSSION differentiation, and the translation of the gonadal sex to phenotypic sex (Passello-Legrand and Mowat, In mammals, genital developmental disorders 2004). Differentiation along ovary or testis pathways have been described in numerous species including is determined by the sex chromosomal constitution humans, pigs, goats, horses, dogs, mice, marsupials of the embryo, which is established as XX or XY and moles (Cribiu and Chaffaux, 1990; Pailhoux et at fertilization. The Y-chromosome carries a domi- al., 2001; Kim and Kim, 2006). The term hermaph- nant inducer of testis development, the SRY gene rodite is used independently of the chromosomal (sex-determining region of Y) (Sinclair et al., 1990). constitution. The individuals may have an ovary on The development of the testis is initiated by the SRY one side and a testis on the other or they may have gene and in its absence the ovarian differentiation combined ovotestes (Kai et al., 2003). They may be normally occurs (Sinclair et al., 1990; Kennedy and classified as bilateral (testis and ovary or ovotestis Miller, 1993; Hubler et al., 1999).

76 Veterinarni Medicina, 52, 2007 (2): 74–78 Case Report

The phenotypic sex is regulated by the gonads Failures in the establishment of chromosomal, go- after their differentiation (Kennedy and Miller, nadal and phenotypic sex can cause intersexuality in 1993; Hubler et al., 1999). If the gonad develops dogs. Thus, the diagnosis of sex reversal syndrome, along a testicular pathway, two hormones respon- male or female pseudohermaphroditism in intersex sible for phenotypic masculinization are produced, individuals has to be based on the inspection of chro- Mullerian inhibiting factor (MIF) and testoster- mosomes, gonads and the phenotypic appearance of one. The Sertoli cells secrete MIF (Hubler et al., the reproductive organs (Svendsen et al., 1985; Kuiper 1999) and in the absence of this substance pas- and Distl, 2004). As these animals did not receive any sive development of the Mullerian ductal system hormonal treatment during their lives, and based on takes place, no stimulatory factor being required. the histological characteristics of their gonads, they Testosterone is also responsible for masculinization were considered to be spontaneous male pseudoher- of the external genitalia. For this action to occur, maphrodites, probably caused by a genetic disorder. testosterone must be converted into dihydrotes- The present cases were classified as male pseudoher- tosterone (DHT). This transformation is effected maphrodites (MPH) because of the presence of testes in the target tissue itself, the cells of the external and ambiguity of external genitalia. genitalia. Thus, DHT promotes the formation of and failure of androgen dependent masculinization of the prostate, urethra, and scrotum (Kennedy the external genitalia might be due to the dysfunction and Miller, 1993; Hubler et al., 1999). In the absence of embryonic testes. of DHT, the external genitalia will develop along female lines. In the present cases, hyperoestro- genism and low testosterone levels are thought to REFERENCES contribute to the dysgenesis of the male external genitalia and unilateral or bilateral cryptorchidism Brown T.T., Buerk J.D., McEntee K. (1976): Male pseu- (Brown et al., 1976). dohermaphroditism, cryptorchism, and Sertoli cell Androgen resistance or disorders of androgen neoplasia in three miniature schnauzers. Journal of biosynthesis are also thought to cause male pseu- American Veterinary Medical Association, 169, 821– dohermaphroditism. Sometimes male hormones 825. cannot exert their full effects on the tissues due to Cribiu E.P., Chaffaux S. (1990): Intersexuality in domes- various congenital abnormalities. 5α-reductase de- tic mammals. Reproduction Nutrition Development, ficiency is a form of androgen resistance, in which 1(Suppl.), 51S–61S. the enzyme responsible for the formation of DHT, Del Amo A.N., Luca J.D., Zufriategui L., Armocida A., the active form of testosterone, is decreased (Miller, Barbeito C.G., Gobello C. (2001): Male pseudoher- 2002). There are two 5α-reductase isoenzymes, maphroditism in a dog: A case report. Communica- type 1 and type 2, in humans and animals. In hu- tions in Theriogenology, 1, 1–11. mans, this deficiency is a rare autosomal recessive Howard P.E., Bjorling D.E. (1989). The intersex animal trait, i.e. the result of any of several mutations in associated problems. Problems in Veterinary Medi- the gene encodes the steroid 5a-reductase- 2 gene. cine, 1, 74–84. The type 2 gene is expressed in the foetal genital Hubler M., Hauser B., Meyer-Wallen V.N., Arnold S. skin and in the normal prostate (Miller, 2002). The (1999): SRY-negative XX true hermaphrodites in a bas- mutation in type 2 isoenzymes causes male pseudo- set hound. Theriogenology, 55, 1391–1403. hermaphroditism (Imperato-McGinley et al., 1985; Imperato-McGinley J., Binienda Z., Arthur A., Minin- Passello-Legrand and Mowat, 2004). berg D.T., Vaughan E.D. Jr., Quimby F.W. (1985): The The XX sex reversal, a form of the intersex in development of a male pseudohermaphroditic rat us- which discordance exists between the sex chromo- ing an inhibitor of the enzyme 5 alpha-reductase. En- somal composition and the gonadal and external docrinology, 116, 807–812. phenotype. It is due to a gene referred to as the Kai K., Satoh N., Watanabe A., Shiraiwa K., Sasano H., sex reversal gene (sxr). In dogs sex reversal oc- Furuhama K. (2003): Case report of rat true hermaph- curs most often in American Cocker Spaniels, the roditism: colocalization of oocytes and granulosa and animals reported to be MPH having XX genotype Sertoli cells in the germinal cord. Toxicologic Pathol- and sxr gene located on an autosome (Selden et al., ogy, 31, 290–294. 1984; Kuiper and Distl, 2004). These findings are Kennedy P., Miller R.B. (1993): The female genital sys- in agreement with Case 3 in our report. tem. In: Jubb K.V.F., Kennedy P.C., Palmer N. (eds.): 77 Case Report Veterinarni Medicina, 52, 2007 (2): 74–78

Pathology of Domestic Animals. 4th ed. Academic Sinclair A.H., Berta P., Palmer M.S., Hawkins J. R., Press Inc., San Diego, California. 348–357. Griffths B., Smith M., Foster J., Frischauf A.M., Lovell- Kim K.S., Kim O. (2006): A dog with bi- Badge R., Good Fellow P.N. (1990): A gene from the lateral ovotestes and pyometra. Journal of Veterinary human sex-determining region encodes a portion with Science, 7, 87–88. homology to a conserved DNA-binding modification. Kuiper H., Distl O. (2004): Intersexuality in dogs: causes Nature, 346, 240–244. and genetics. Deutsche tierarztliche Wochenschrift, Svendsen C.K., Thomsen P.D., Basse A. (1985): Two cases 111, 251–258. of male pseudohermaphroditism in the dog. Clinical, Miller W.L. (2002): Disorders of androgen biosynthesis. macroscopic, karyotypic and therapeutic features. Seminars in Reproductive Medicine, 20, 205–215. Nordisk Veterinaermedicin, 37, 358–363. Pailhoux E., Parma P., Sundstrom J., Vigier B., Servel N., Switonski M., Fisher P., Reimann N., Bartnizke S., Bull- Kuopia T., Locatelli A., Pelliniemi L.J., Cotinot C. erdiek J., Ronne M., Pienkowska A., Ladon D., Graph- (2001): Time course of female-to-male sex reversal in odatsky A., Beklemisheva V., Long S., Bosma A., 38, XX foetal and postnatal pigs. Developmental Dy- Moreno-Millán M., De Luca J.C. (1994): International namics, 222, 328–340. efforts for establishing standard karyotype of the dog Passello-Legrand F., Mowat V. (2004): Two cases of spon- (Canis familiaris). Comittee for the standardized taneous pseudohermaphroditism in cynomolgus mon- karyotype of the dog (Canis familiaris). In: Proceeding keys (Macca fascicularis). Journal of Veterinary of the 11th European Colloquium on Cytogenetics of Medicine A, Physiology, Pathology, Clinical Medicine, Domestic Animals. 51, 344–347. Weng Q., Murase T., Asano M., Tsubota T. (2005): Male Selden J.R., Moorhead P.S., Koo G.C., Wachtel S.S., pseudohermaphroditism in a raccoon dog (Nyctereutes Haskins M.E., Patterson D.F. (1984): Inherited XX sex procynoides). Journal of Veterinary Medical Sciences, reversal in the Cocker spaniel dog. Human Genetics, 67, 603–605. 67, 62–69. Received: 2006–10–10 Accepted: 2007–01–11

Corresponding Author: Dr. Nam-Soo Kim, Assoc. Prof., Chonbuk National University, College of Veterinary Medicine, Department of Surgery, and Vice Dean, Academic Affairs, Jeonju 561-756, Republic of Korea Tel. +82 63 270 2800, fax +82 63 270 3778, e-mail: [email protected]

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