Pubertal development in 46,XY patients with NR5A1 mutations

Isabel Mönig*, Julia Schneidewind, Trine H. Johannsen, Anders Juul, Ralf Werner, Ralf Lünstedt, Wiebke Birnbaum, Louise Marshall, Lutz Wünsch, Olaf Hiort

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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Abstract

Purpose: Mutations in the NR5A1 gene, encoding the transcription factor Steroidogenic Factor-1, are associated with a highly variable genital phenotype in patients with 46,XY differences of sex development (DSD). Our objective was to analyse the pubertal development in 46,XY patients with NR5A1 mutations by the evaluation of longitudinal clinical and hormonal data at pubertal age. Methods: We retrospectively studied a cohort of 10 46,XY patients with a verified NR5A1 mutation and describe clinical features including the external and internal genitalia, testicular volumes, Tanner stages and serum concentrations of LH, FSH, testosterone, AMH, and inhibin B during pubertal transition. Results: Patients who first presented in early infancy due to ambiguous genitalia showed spontaneous virilization at pubertal age accompanied by a significant testosterone production despite the decreased gonadal volume. Patients with apparently female external genitalia at birth presented later in life at pubertal age either with signs of virilization and/or absence of female puberty. Testosterone levels were highly variable in this group. In all patients, gonadotropins were constantly in the upper reference range or elevated. Neither the extent of virilization at birth nor the presence of Müllerian structures reliably correlated with the degree of virilization during puberty. Conclusion: Patients with NR5A1 mutations regardless of phenotype at birth may demonstrate considerable virilization at puberty. Therefore, it is important to consider sex assignment carefully and avoid irreversible procedures during infancy.

OriginalsprogEngelsk
TidsskriftEndocrine
Vol/bind75
Udgave nummer2
Sider (fra-til)601-613
Antal sider13
ISSN1355-008X
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
Generation of reference ranges received financial support through funding to the COPENHAGEN Puberty Study (ClinicalTrials.gov no. NCT01411527) from research funds of Capital Region and Rigshospitalet, and from the Kirsten and Freddy Johansen Foundation. Open Access funding enabled and organized by Projekt DEAL.

Publisher Copyright:
© 2021, The Author(s).

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