DOCSLIB.ORG

Disorders of Sex Development/Intersex in Children and Adolescents

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Disorders of Sex Development/Intersex in Children and Adolescents FOCUS | CLINICAL A guide to differences/ disorders of sex development/intersex in children and adolescents Komal A Vora, Shubha Srinivasan DIFFERENCES/DISORDERS of sex development consensus about nomenclature and (DSD) or ‘intersex’ encompass a wide optimal management. Promoting a range of conditions usually presenting non-binary view of sex and gender can be Background Differences/disorders of sex in the newborn period or adolescence. helpful to work towards common goals of development (DSD) or ‘intersex’ Most are relatively rare, and the overall optimal care. There is limited evidence encompass a broad range of congenital incidence depends on which conditions are to support and/or guide clinical decision variations in the complex pathways included; for example: making that involves the consideration involved in the development of sex • Klinefelter syndrome (47,XXY) – one in of medical, human rights, ethical and characteristics. Components of these 450 births of male infants1 legal aspects.5 Moreover, there has pathways include sex chromosomes, discordance between phenotypic been considerable debate regarding genes involved in gonadal development, • hormone production and action, and the and genotypic sex at birth – one in the indication and timing of surgical 2 development of internal and external 4500–5500 births interventions for minors with DSD. genital structures. Many variations are • congenital adrenal hyperplasia (CAH) – Clinical features and underlying rare, and some (eg congenital adrenal one in 14,000 births3 pathophysiology vary from one individual hyperplasia) are associated with urgent • complete XX or XY sex reversal – one in with a DSD to another. As a result, medical needs. People born with 20,000 births2 presentations can range from atypical variations in sex characteristics may ovotesticular DSD – one in 100,000 genitalia in infancy to atypical pubertal present in the neonatal period with • 2 atypical genitalia, during childhood births. development in adolescence to fertility and adolescence with atypical pubertal Terminology has been a source of concerns in adulthood. Throughout the development or in adulthood with dissatisfaction among many affected lifespan, there can be challenging and hormone imbalance, fertility issues individuals, with some peer support sensitive discussions and decisions, such and/or sexual health concerns. groups having a strong preference for as the appropriate sex of rearing, gender 4 Objective ‘intersex’ over ‘DSD’, while others identity, potential for future adult sexual An overview of DSD is presented in actively dissociate from the term functioning and fertility. Healthcare relation to presenting features and ‘intersex’. Clinicians generally avoid professionals may face pressure for management challenges in the either term when speaking with affected urgent diagnosis and management at paediatric population. individuals and their families, choosing presentation but also need to consider a Discussion to use terminology based on the diagnosis medium-term and long-term plan with the An experienced multidisciplinary team whenever possible (eg CAH, Klinefelter child/adolescent and family in the context that uses a shared decision-making syndrome). However, DSD/intersex can of the social and cultural environment. approach with a medical, surgical, be useful umbrella terms in the context Psychological support should be provided ethical, psychological and human rights of medical literature and policy. The throughout the patient journey. framework is required to maximise long- diverse clinical features, pathophysiology As a result of the rarity of many term positive outcomes for people born with variations in sex characteristics. and management challenges in DSD conditions, data on long-term outcomes have compounded efforts to reach are limited, and patient groups as well © The Royal Australian College of General Practitioners 2020 REPRINTED FROM AJGP VOL. 49, NO. 7, JULY 2020 | 417 FOCUS | CLINICAL A GUIDE TO DIFFERENCES/DISORDERS OF SEX DEVELOPMENT/INTERSEX IN CHILDREN AND ADOLESCENTS as professionals have challenged aspects ovotestis as ovaries tend to remain in requires an individualised approach taking of clinical care that were previously pelvic position.9 DSD may also be part of into consideration prenatal androgen considered as standard. Through greater a multisystem disorder with coexistent exposure, fertility potential, quality of use of multidisciplinary teams (MDTs), metabolic abnormalities or dysmorphic sexual function, surgical options, gonadal development of patient registries and features. CAH is the most common pathology/malignancy risk and potential international collaboration, the evidence cause of genital ambiguity in infancy adult gender identity.2 Given the variation base for the best standards of care will and should be considered in any baby and complexity of different types of DSD, continue to develop. with genital ambiguity, shock and/or it may be difficult to extrapolate outcomes hyponatraemia and hyperkalaemia.10 It is for each individual. Research in DSD a potentially life-threatening condition and gender identity has only been done Classification and diagnosis of DSD and requires urgent treatment with in larger subgroups such as patients with The development of the 2006 consensus high-dose hydrocortisone to prevent an CAH and androgen insensitivity syndrome. guidelines6 was a turning point in the adrenal crisis. To date, evidence suggests sex of rearing classification of DSD, with three broad Initial investigations for genital ambiguity is an important but imperfect predictor categories: sex chromosomal DSD, include karyotype and/or rapid polymerase of gender identity, with some additional 46,XX DSD and 46,XY DSD (Box 1). chain reaction or fluorescence in situ contribution of prenatal androgen This resulted in the abandonment of hybridisation for Y material, glucose, exposure in male gender identity.11 misleading and pejorative terms such electrolytes, 17-hydroxyprogesterone as ‘hermaphrodite’. Diagnosis of DSD (17-OHP), gonadotropins, oestradiol generally involves a hormone profile and testosterone. Results should be Children and adolescents work-up, genetic testing and visualisation interpreted in the context of the baby’s Simple virilising CAH may present in of internal reproductive structures, gestational and chronological age. childhood with a rapid growth spurt, through either medical imaging or The paediatric endocrinologist may exaggerated signs of adrenarche (eg pubic laparoscopy. These investigations are request further testing including pelvic hair) and virilisation of the genitalia, with coordinated by a member of the MDT, ultrasonography, urine steroid profile, clitoromegaly or penile growth without often the paediatric endocrinologist.7 serum anti-Müllerian hormone, human testicular enlargement.10 A 17-OHP level, Throughout the diagnostic work-up and chorionic gonadotropin stimulation test synacthen test and genotyping are useful discussion of results and management and DSD gene panels. investigations for diagnosis. plans, it is paramount that there is an Sex assignment is a dilemma in a small Presenting features of DSD in an open and transparent discussion with percentage of patients with DSD and adolescent may include delayed puberty, parents and affected individuals at developmentally appropriate times. Box 1. Summary of classification of differences/disorders of sex development taken from the 2006 consensus statement6 Neonates 46,XY DSD Neonates who require diagnostic work-up • Disorders of testicular development, including partial and complete testicular dysgenesis, include those with ambiguous or atypical testicular regression and ovotesticular DSD genitalia or less obvious findings such as • Disorders of androgen biosynthesis (eg 5-alpha reductase deficiency) or action (CAIS, bilateral nonpalpable gonads, palpable PAIS, luteinising hormone receptor defects) gonads in labioscrotal folds, perineal • AMH disorders (eg persistent Müllerian duct syndrome) hypospadias, undervirilised phallus, • Other disorders, including severe hypospadias and cloacal exstrophy clitoromegaly or discordant genital 46,XX DSD appearance to prenatal genetic test. • Disorders of ovarian development, including ovarian dysgenesis as well as testicular The initial evaluation should include a or ovotesticular DSD thorough pregnancy and family history • Disorders of androgen excess of either fetal, fetoplacental or maternal origin and clinical examination. Physical • Other disorders, including cloacal exstrophy, MURCS and vaginal atresia examination should include evaluation Sex chromosome DSD of general health, hydration state, blood Disorders related to atypical arrangement of sex chromosomes, including: pressure and appearance of external • missing sex chromosome (eg 45,X, as seen with Turner syndrome) genitalia with regards to whether the • additional sex chromosome (eg 47,XXY, as seen with Klinefelter syndrome) labioscrotal folds are fused, the presence • more than one type of sex chromosome arrangement (eg 45,X/46,XY or 46,XX/46,XY) of palpable gonads, the location of the urethral meatus and the size of the AMH, anti-Müllerian hormone; CAIS, complete androgen insensitivity syndrome; DSD, differences/ phallus/clitoris.8 Palpable gonads are disorders of sex development; MURCS, Müllerian, renal, cervicothoracic somite abnormalities; PAIS, partial androgen insensitivity syndrome most commonly testes and occasionally 418 | REPRINTED FROM AJGP VOL. 49, NO. 7,
Load more

Recommended publications
  • Neonatal Case of Mckusick-Kaufman Syndrome Difficulty of Diagnosis
    Neonat f al l o B Imen et al., J Neonatal Biol 2016, 5:4 a io n l r o u g y DOI: 10.4172/2167-0897.1000235 o J Journal of Neonatal Biology ISSN: 2167-0897 Case Report Open Access Neonatal Case of Mckusick-Kaufman Syndrome Difficulty of Diagnosis and Management Ksibi Imen1, Achour Radhouane2*, Ben Jamaa Nadia3, Bennour Wafa1, Cheour Meriem1, Ben Amara Moez1, Ayari Fayrouz1, Ben Ameur N1, Aloui Nadia4, Neji KHaled2, Masmoudi Aida3 and Kacem Samia1 1Neonatal Intensive Care Unit, Center of Maternity and Neonatology of Tunis, University Tunis El Manar, Tunisia 2Department of Emergency, Center of Maternity and Neonatology of Tunis, University Tunis El Manar, Tunisia 3Department of Foetopathology, Center of Maternity and Neonatology of Tunis, University Tunis El Manar, Tunisia 4Department of Radiology, Center of Maternity and Neonatology of Tunis, University Tunis El Manar, Tunisia Abstract McKusick-Kaufman syndrome (MKKS) is a rare autosomal recessive disorder. We report the case of McKusick- Kaufman syndrome in a term female neonate. Antenatal ultrasound found a large cystic abdominal mass corresponding to hydrometrocolpos with bilateral hydronephrosis. This finding was confirmed after birth and its association to polydactyly permitted us to give the diagnosis of MKKS. Exploratory laparotomy revealed vaginal atresia and suspected the association to Hirschprung disease. MKKS is difficult to diagnose antenatally and complementary explorations should be done after birth to establish a definitive diagnosis. Keywords: McKusick-Kaufman syndrome; Neonate; Hydronephrosis; pressure from the urinary tract, about 150 ml of an opalescent fluid was Polydactyly; Vaginal atresia; Laparotomy; Ultrasound aspirated from the enlarged uterus.
    [Show full text]
  • Intersex Genital Mutilations Human Rights Violations of Children with Variations of Reproductive Anatomy
    Intersex Genital Mutilations Human Rights Violations Of Children With Variations Of Reproductive Anatomy NGO Report (for LOI) to the 9th Periodic Report of Austria on the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) Compiled by: StopIGM.org / Zwischengeschlecht.org (International Intersex Human Rights NGO) Markus Bauer, Daniela Truffer Zwischengeschlecht.org P.O.Box 2122 CH-8031 Zurich info_at_zwischengeschlecht.org http://Zwischengeschlecht.org/ http://stop.genitalmutilation.org/ October 2018 This NGO Report online: PDF: http://intersex.shadowreport.org/public/2018-CEDAW-LOI-Austria-NGO-Zwischengeschlecht-Intersex-IGM.pdf 2 Executive Summary All typical forms of Intersex Genital Mutilation are still practised in Austria, facilitated and paid for by the State party via the public health system. Parents and children are misinformed, kept in the dark, sworn to secrecy, kept isolated and denied appropriate support. Austria is in breach of its obligations to (a) take effective legislative, administrative, judicial or other measures to prevent involuntary, non-urgent genital surgery and other harmful medical treatment of intersex children, (b) to ensure access to justice, redress, compensation and rehabilitation for victims, and c) to provide families with intersex children with adequate psychosocial and peer support (art. 5). CAT has already considered IGM in Austria as constituting at least cruel, inhuman or degrading treatment (CAT/C/AUT/CO/6, paras 44–45). Nonetheless, to this day the Austrian Government fails to act. In total, UN treaty bodies CRPD, CRC, CAT, CEDAW and CCPR have so far issued 36 Concluding Observations on IGM, typically obliging State parties to enact legislation to (a) end the practice and (b) ensure redress and compensation, plus (c) access to free counselling.
    [Show full text]
  • The XY Gonadal Agenesis Syndrome GLORIA E
    J Med Genet: first published as 10.1136/jmg.10.3.288 on 1 September 1973. Downloaded from Journal of Medical Genetics (1973). 10, 288. The XY Gonadal Agenesis Syndrome GLORIA E. SARTO and JOHN M. OPITZ Departments of Gynecology and Obstetrics, Pediatrics and Medical Genetics, University of Wisconsin Center for Health Sciences and Medical School, Madison, Wisconsin, USA Summary. A patient with a 46,XY chromosome constitution showed the following main characteristics: eunuchoidal body habitus, lack of secondary sexual development, normal female external genitalia with absence of vagina, no gonadal structures, and complete lack of internal genitalia except for rudimentary ductal structures defined by histological examination. Her condition is clearly different from that of feminizing testis syndrome and Swyer syndrome individuals. We would like to include her and six similar patients from the literature in a newly de- fined 'XY gonadal agenesis' syndrome. In mammals, the male sex determining 'factor(s)' tive. Intravenous pyelography disclosed no abnor- is located on the Y chromosome. Though the pre- malities of kidneys, ureters, or bladder. At exploratory sence of a Y chromosome is able to overcome the laparotomy, no internal genitalia or gonads were found. effects of more than one X chromosome in determin- At the left pelvic wall was a small mass of tissue (measur- ing 1 0 x 0 5 cm) to which was attached a rudimentary ing the male sex, a number of genes, not on the Y fallopian tube. Similar, but smaller structures werecopyright. chromosome, are able to disturb this role. The best present on the right; microscopic examination of these known examples of this phenomenon are the confirmed the diagnosis of a rudimentary fallopian feminizing testis syndrome (FTS) and the Swyer tube.
    [Show full text]
  • MKKS Is a Centrosome-Shuttling Protein Degraded by Disease
    Molecular Biology of the Cell Vol. 19, 899–911, March 2008 MKKS Is a Centrosome-shuttling Protein Degraded by Disease-causing Mutations via CHIP-mediated Ubiquitination Shoshiro Hirayama,* Yuji Yamazaki,* Akira Kitamura,* Yukako Oda,* Daisuke Morito,* Katsuya Okawa,† Hiroshi Kimura,‡ Douglas M. Cyr,§ Hiroshi Kubota,*ሻ and Kazuhiro Nagata*ሻ *Department of Molecular and Cellular Biology and ࿣Core Research for Evolutional Science and Technology/ Japan Science and Technology Agency, Institute for Frontier Medical Sciences, Kyoto University, Kyoto 606- 8397, Japan; †Biomolecular Characterization Unit and ‡Nuclear Function and Dynamics Unit, Horizontal Medical Research Organization, School of Medicine, Kyoto University, Kyoto 606-8501, Japan; and §Department of Cell and Developmental Biology and UNC Cystic Fibrosis Center, School of Medicine, University of North Carolina, Chapel Hill, NC 27599 Submitted July 3, 2007; Revised November 21, 2007; Accepted December 10, 2007 Monitoring Editor: Jeffrey Brodsky McKusick–Kaufman syndrome (MKKS) is a recessively inherited human genetic disease characterized by several developmental anomalies. Mutations in the MKKS gene also cause Bardet–Biedl syndrome (BBS), a genetically hetero- geneous disorder with pleiotropic symptoms. However, little is known about how MKKS mutations lead to disease. Here, we show that disease-causing mutants of MKKS are rapidly degraded via the ubiquitin–proteasome pathway in a manner dependent on HSC70 interacting protein (CHIP), a chaperone-dependent ubiquitin ligase. Although wild-type MKKS quickly shuttles between the centrosome and cytosol in living cells, the rapidly degraded mutants often fail to localize to the centrosome. Inhibition of proteasome functions causes MKKS mutants to form insoluble structures at the centrosome. CHIP and partner chaperones, including heat-shock protein (HSP)70/heat-shock cognate 70 and HSP90, strongly recognize MKKS mutants.
    [Show full text]
  • Vaginal Reconstruction for Distal Vaginal Atresia Without Anorectal Malformation: Is the Approach Diferent?
    Pediatric Surgery International (2019) 35:963–966 https://doi.org/10.1007/s00383-019-04512-2 ORIGINAL ARTICLE Vaginal reconstruction for distal vaginal atresia without anorectal malformation: is the approach diferent? Andrea Bischof1 · Veronica I. Alaniz2 · Andrew Trecartin1 · Alberto Peña1 Accepted: 20 June 2019 / Published online: 29 June 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Introduction Distal vaginal atresia is a rare condition and treatment approaches are varied, usually driven by symptoms. Methods A retrospective review was performed to identify patients with distal vaginal atresia without anorectal malforma- tion. Data collected included age and symptoms at presentation, type and number of operations, and associated anomalies. Results Eight patients were identifed. Four presented at birth with a hydrocolpos and four presented with hematomet- rocolpos after 12 years of age. Number of operations per patient ranged from one to seven with an average of three. The vaginal reconstruction was achieved by perineal vaginal mobilization in four patients and abdomino-perineal approach in four patients. One patient, with a proximal vagina approximately 7 cm from the perineum, required partial vaginal replace- ment with colon. In addition, she had hematometrocolpos with an acute infammation at the time of reconstruction despite menstrual suppression and drainage which may have contributed to the difculty in mobilizing the vagina. In fve patients, distal vaginal atresia was an isolated anomaly. In the other three cases, associated anomalies included: mild hydronephrosis that improved after hydrocolpos decompression (2), cardiac anomaly (2), and vertebral anomaly (1). Conclusion In this series, a distended upper vagina/uterus was a common presentation and the time of reconstruction was driven by the presence of symptoms.
    [Show full text]
  • Perinatal/Neonatal Casebook ⅢⅢⅢⅢⅢⅢⅢⅢⅢⅢⅢⅢⅢⅢ Special Imaging Casebook
    Perinatal/Neonatal Casebook nnnnnnnnnnnnnn Special Imaging Casebook Marilyn J. Siegel, Section Editor infant was noted to have bilateral postaxial polydactyly of the hands. Because of a bulging membrane at the vaginal introitus, perforation Contributed by: Thomas E. Herman, MD of a presumed hymen was performed with copious return of fluid. The Marilyn J. Siegel, MD child was then transferred to this hospital for further evaluation and treatment. Further evaluation, including fundoscopic examination, revealed a pigmented retinopathy. Sonography of the kidneys (Figure Case Presentation 1) and a voiding cystourethrogram and genitogram (Figure 2) were A 3800-gm girl was born at term at a rural hospital after an uncom- also performed. plicated pregnancy to a 28-year-old gravida 1, para 1 mother. The From Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo. Address correspondence and reprint requests to Thomas E. Herman, MD, Mallinckrodt Insti- tute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., St. Louis, MO 63110. Denouement and Discussion NEONATAL BARDET–BIEDL SYNDROME WITH RENAL ANOMALIES AND HYDROCOLPOS WITH VESICOVAGINAL FISTULA Ophthalmologic, genetic, and imaging studies were all consistent neys with parenchymal thinning; bilateral, multiple renal calyceal with the Bardet-Biedl syndrome. The imaging studies demon- diverticula (multidiverticular renal dysplasia); and a histologic glo- strated a vesicovaginal fistula, an enlarged vagina, after treatment merulopathy and tubulo-interstitial nephropathy.3–5 Complications of for hydrocolpos at the outside hospital, and multidiverticular renal multidiverticular renal dysplasia include infection and stone forma- dysplasia. Bardet-Biedl syndrome is an autosomal recessive condi- tion.2 The earliest finding of clinical renal disease is usually polydip- tion previously referred to as Laurence-Moon-Bardet-Biedl syn- sia and polyuria due to a concentrating ability resulting from de- drome.
    [Show full text]
  • Management of Partial Vaginal Atresia in Infancy: Early Experience
    Annals of Pediatric Surgery, Vol 2, No 3-4, July- October 2006, PP 174-179 Original Article Management of Partial Vaginal Atresia in Infancy: Early Experience Omar Mansour*, Hani Morsi** Departments of General Surgery* and Urology**, Cairo University Children's Specialized Hospital, Faculty of Medicine, Cairo University, Egypt Background/ Purpose: Transverse vaginal septum or partial vaginal agenesis is a subtype of vaginal atresia characterized by uterovaginal obstruction. This study was carried out to highlight the various patterns of clinical presentations, management options and outcome of this rare congenital anomaly. Materials & Methods: Eleven female patients presenting with manifestations related to uterovaginal obstruction during infancy were studied. Proper clinical evaluation and imaging studies including ultrasonography and computerized tomography were done. Cystovaginoscopy and laparoscopy were used for better delineation of the genitalia, adnexa and the uterus besides guiding for drainage and incision of the vaginal septum. Each patient was evaluated as regard to the age at presentation, presenting symptoms, associated malformations, imagining studies, operative details, and outcome Results: The main presenting symptoms were related to genitourinary obstruction. Endoscopic guided laparoscopic assisted division of the septum was done in 6 patients. Preliminary vaginostomy followed by vaginal pullthrough was done in 3 patients, and only endoscopic incision of the septum was done in 2 patients. No reported major complications were encountered during 1 year follow up. Conclusion: Diagnosis of transverse vaginal septum is still a challenge during early infancy .Division of the septum together with vaginal pull-through was found to facilitate marsupialization of the incised septum to the edges of the introitus. Incision of the septum guided by laparoscopy and vaginoendoscopy can minimize accidental injuries to the bladder, rectum and urethra.
    [Show full text]
  • Jebmh.Com Original Article
    Jebmh.com Original Article ROLE OF MRI IN EVALUATION OF MRKH SYNDROME Lalitha Kumari G1, B. E. Panil Kumar2, M. V. Ramanappa3, Sreedhar Reddy B4, Madhu Madhava Reddy5 1Assistant Professor, Department of Radiodiagnosis, Santhiram Medical College & General Hospital, Nandyal, Kurnool. 2Professor, Department of Radiodiagnosis, Santhiram Medical College & General Hospital, Nandyal, Kurnool. 3Professor & HOD, Department of Radiodiagnosis, Santhiram Medical College & General Hospital, Nandyal, Kurnool. 4Assistant Professor, Department of Radiodiagnosis, Santhiram Medical College & General Hospital, Nandyal, Kurnool. 5Post Graduate, Department of Radiodiagnosis, Santhiram Medical College & General Hospital, Nandyal, Kurnool. ABSTRACT: MRKH Syndrome is one of diverse spectrum of congenital mullerian duct anamolies ranging from complete absence to hypoplasia of uterus and upper 2/3rd of vagina owing to their embryological origin. This is the second most common cause of primary amennorhoea in young females who shows normal development of secondary sexual characters and endocrine profile with essential normal female phenotype & genotype (46 XX). Our study is to emphasis the role of MRI in diagnosis of this syndrome non-invasively without exposure to radiation. The excellent soft tissue anatomical details by MRI provides the diagnosis with accuracy along with information of adjacent viscera and other associated systemic anamolies. KEYWORDS: Magnetic Resonance Imaging (MRI), Mullerian agenesis, Mayer Rokitansky Kuster Hauser Syndrome (MRKH syndrome). HOW TO CITE THIS ARTICLE: Lalitha Kumari G, B. E. Panil Kumar, M. V. Ramanappa, Sreedhar Reddy B, Madhu Madhava Reddy. “Role of MRI in Evaluation of MRKH Syndrome”. Journal of Evidence based Medicine and Healthcare; Volume 2, Issue 50, November 23, 2015; Page: 8555-8560, DOI: 10.18410/jebmh/2015/1178 INTRODUCTION: MRKH Syndrome is the most common The final cohort consisted of 12 patients (age range 14 example of Class I mullerian duct anamolies (American to 25 yrs, mean age 19.5 years).
    [Show full text]
  • A New Case of Bardet-Biedl Syndrome Associated With
    and an MODY diabetes. At present blood glucose and glycated hemoglobin Results: :H REVHUYHG D VLJQL¿FDQW UHGXFWLRQ RI PHQVWUXDO EOHHGLQJ DQG D are normal, renal function is stable. VLJQL¿FDQWUHGXFWLRQLQWKHGRVHVRIWKHVSHFL¿FIDFWRUV$OOWKHSDWLHQWVZHUH Conclusions: +1)ȕPXWDWLRQLVZHOONQRZQWRQHSKURORJLVWVZHPXVWQRW evaluated by DEXA to precociously evidence a reduction in bone mineral IRUJHWWKDWWKHJ\QHFRORJLFDOH[DPLQDWLRQLVHVVHQWLDOLQWKHFRQWH[WRIDVVRFL - GHQVLW\ %0' %0'YDOXHVZHUHLQWKHQRUPDOUDQJHIRUDJHDQGVH[DOVRLQ ated malformations. patients treated with DDAVP and E2. However our patients received DDAVP for few days/month and E2 from<3years. Conclusions: We stress the role of endocrine follow up in patients with se- ______________________________________ vere coagulopathies. The correct age to start estroprogestinic therapy must P2-d3-670 Gonads and Gynaecology 2 be evaluated by the endocrinologist, to prevent a poor growth prognosis and A new case of Bardet-Biedl syndrome osteopenia. associated with vaginal atresia and uterus hypoplasia ______________________________________ Leyla Akin 1; Selim Kurtoglu 1; Mustafa Kendirci 1; Mustafa Kucukaydin 2 P2-d3-672 Gonads and Gynaecology 2 1Erciyes University Faculty of Medicine, Pediatric Endocrinology, Glucocorticoid resistance (GR) is a novel Kayseri, Turkey; 2Erciyes University Faculty of Medicine, Pediatric Surgery, Kayseri, Turkey reason for polycystic ovarian syndrome Steven Ghanny 1; Lina Nie 1; Duanjun Tan 2; Iuliana Predescu 1; Natia Pantsulaian1; Pascal Philibert 3; George Chrousos 4; Background:
    [Show full text]
  • EUROCAT Syndrome Guide
    JRC - Central Registry european surveillance of congenital anomalies EUROCAT Syndrome Guide Definition and Coding of Syndromes Version July 2017 Revised in 2016 by Ingeborg Barisic, approved by the Coding & Classification Committee in 2017: Ester Garne, Diana Wellesley, David Tucker, Jorieke Bergman and Ingeborg Barisic Revised 2008 by Ingeborg Barisic, Helen Dolk and Ester Garne and discussed and approved by the Coding & Classification Committee 2008: Elisa Calzolari, Diana Wellesley, David Tucker, Ingeborg Barisic, Ester Garne The list of syndromes contained in the previous EUROCAT “Guide to the Coding of Eponyms and Syndromes” (Josephine Weatherall, 1979) was revised by Ingeborg Barisic, Helen Dolk, Ester Garne, Claude Stoll and Diana Wellesley at a meeting in London in November 2003. Approved by the members EUROCAT Coding & Classification Committee 2004: Ingeborg Barisic, Elisa Calzolari, Ester Garne, Annukka Ritvanen, Claude Stoll, Diana Wellesley 1 TABLE OF CONTENTS Introduction and Definitions 6 Coding Notes and Explanation of Guide 10 List of conditions to be coded in the syndrome field 13 List of conditions which should not be coded as syndromes 14 Syndromes – monogenic or unknown etiology Aarskog syndrome 18 Acrocephalopolysyndactyly (all types) 19 Alagille syndrome 20 Alport syndrome 21 Angelman syndrome 22 Aniridia-Wilms tumor syndrome, WAGR 23 Apert syndrome 24 Bardet-Biedl syndrome 25 Beckwith-Wiedemann syndrome (EMG syndrome) 26 Blepharophimosis-ptosis syndrome 28 Branchiootorenal syndrome (Melnick-Fraser syndrome) 29 CHARGE
    [Show full text]
  • Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome
    Orphanet Journal of Rare Diseases BioMed Central Review Open Access Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome Karine Morcel1,2, Laure Camborieux3, Programme de Recherches sur les Aplasies Müllériennes (PRAM)4 and Daniel Guerrier*1 Address: 1CNRS UMR 6061, Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes 1, IFR140 GFAS, Faculté de Médecine, Rennes, France, 2Département d'Obstétrique, Gynécologie et Médecine de la Reproduction Hôpital Anne de Bretagne, Rennes, France, 3Association MAIA, Toulouse, France and 4Programme de Recherches sur les Aplasies Müllériennes (PRAM) – Coordination at: CNRS UMR 6061, Institut de Génétique et Développement de Rennes (IGDR), Université de Rennes 1, IFR140 GFAS, Faculté de Médecine, Rennes, France Email: Karine Morcel - [email protected]; Laure Camborieux - [email protected]; Programme de Recherches sur les Aplasies Müllériennes (PRAM) - [email protected]; Daniel Guerrier* - [email protected] * Corresponding author Published: 14 March 2007 Received: 16 October 2006 Accepted: 14 March 2007 Orphanet Journal of Rare Diseases 2007, 2:13 doi:10.1186/1750-1172-2-13 This article is available from: http://www.OJRD.com/content/2/1/13 © 2007 Morcel et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is characterized by congenital aplasia of the uterus and the upper part (2/3) of the vagina in women showing normal development of secondary sexual characteristics and a normal 46, XX karyotype.
    [Show full text]
  • Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome: a Comprehensive Update Morten Krogh Herlin1,2* , Michael Bjørn Petersen1,3 and Mats Brännström4
    Herlin et al. Orphanet Journal of Rare Diseases (2020) 15:214 https://doi.org/10.1186/s13023-020-01491-9 REVIEW Open Access Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome: a comprehensive update Morten Krogh Herlin1,2* , Michael Bjørn Petersen1,3 and Mats Brännström4 Abstract Background: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, also referred to as Müllerian aplasia, is a congenital disorder characterized by aplasia of the uterus and upper part of the vagina in females with normal secondary sex characteristics and a normal female karyotype (46,XX). Main body: The diagnosis is often made during adolescence following investigations for primary amenorrhea and hasanestimatedprevalenceof1in5000livefemalebirths.MRKH syndrome is classified as type I (isolated uterovaginal aplasia) or type II (associated with extragenital manifestations). Extragenital anomalies typically include renal, skeletal, ear, or cardiac malformations. The etiology of MRKH syndrome still remains elusive, however increasing reports of familial clustering point towards genetic causes and the use of various genomic techniques has allowed the identification of promising recurrent genetic abnormalities in some patients. The psychosexual impact of having MRKH syndrome should not be underestimated and the clinical care foremost involves thorough counselling and support in careful dialogue with the patient. Vaginal agenesis therapy is available for mature patients following therapeutical counselling and education with non-invasive vaginal dilations recommended as first-line
    [Show full text]