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2018-10-17

Predicting puberty in partial androgen insensitivity syndrome: Use of clinical and functional androgen receptor indices.

EBioMedicine. 2018 Oct 10. pii: S2352-3964(18)30406-7. doi: 10.1016/j.ebiom.2018.09.047. [Epub ahead of print]

Predicting puberty in partial androgen insensitivity syndrome: Use of clinical and functional androgen receptor indices.

Lek N1, Tadokoro-Cuccaro R2, Whitchurch JB3, Mazumder B3, Miles H2, Prentice P2, Bunch T2, Zielińska K2, Metzler V4, Mongan NP4, Heery DM3, Hughes IA5.

Author information イギリス

Abstract

BACKGROUND:

PAIS exhibits a complex spectrum of phenotypes and pubertal outcomes. The paucity of reliable prognostic indicators can confound management decisions including sex-of-rearing. We assessed whether external masculinisation score (EMS) at birth or functional assays correlates with pubertal outcome in PAIS patients and whether the EMS is helpful in sex assignment.

METHODS:

We collected pubertal outcome data for 27 male-assigned PAIS patients, all with confirmed androgen receptor (AR) mutations, including two previously uncharacterized variants (I899F; Y916C). Patients were grouped as follows; EMS at birth <5 and ≥ 5 (EMS in normal males is 12; median EMS in PAIS is 4·7) and pubertal outcomes compared.

FINDINGS:

Only 6/9 patients (67%) with EMS <5 underwent spontaneous onset of puberty, versus all 18 patients with EMS ≥5 (p = .03). Only 1/6 patients (17%) with EMS <5 developed adult genitalia reaching Tanner stage 4 or 5, versus 11/13 (85%) with EMS ≥5 (p = 0·01). There was no significant difference between the two groups of patients in being prescribed androgen replacement, who reached adult testicular volume ≥ 15 ml, pubic hair Tanner stage 4 or 5, above average adult height, had gynaecomastia, and mastectomy. No correlation was observed between EMS and in vitro AR function.

INTERPRETATION:

In PAIS with AR mutation, birth EMS is a simple predictor of spontaneous pubertal onset and satisfactory adult genitalia. This provides useful information when discussing the likely options for management at puberty.



FUND: European Commission Framework 7 Programme, NIHR Cambridge Biomedical Research Centre, BBSRC DTP.
Copyright © 2018. Published by Elsevier B.V.

KEYWORDS:
Androgen insensitivity; Androgen receptor; External masculinisation score; Gynaecomastia; Mutation; Puberty outcome; Reporter assays; Sex assignment; in silico modelling