OBJECTIVE: To explore the clinical, neuropathological and genetic characteristics of a patient with Perrault syndrome caused by TWNK mutation. METHODS: Potential variation of the TWNK gene was detected by next-generation sequencing (NGS) and verified by Sanger sequencing. RESULTS: The patient has featured primary amenorrhoea and progressive sensorineural hearing loss since childhood. She also had gait anormaly, distal limb atrophy and weakness, and nystagmus. Further study confirmed sensory neuronopathy accompanied with upper and lower motor neuron involvement as well as cerebellum atrophy. NGS has identified two heterozygous variants of the TWNK gene, namely c.794G>A (p.Arg265His) and c.1181G>A (p.Arg394His). Sanger sequencing confirmed that c.1181G>A (p.Arg394His), a known pathogenic variant, was derived from her farther, while c.794G>A(p.Arg265His), a novel variant, was derived from her mother and likely pathogenic according to the ACMG guidelines. CONCLUSION Perrault syndrome is a group of disorders with a high phenotypic heterogeneity. The compound heterozygous variation of c.794G>A (p.Arg265His) and c.1181G>A(p.Arg394His) of the TWNK gene may underlie Perrault syndrome in the patient.
Child ; Female ; Genetic Testing ; Gonadal Dysgenesis, 46,XX ; Hearing Loss, Sensorineural ; Humans ; Pedigree

In order to investigate the relationship between sex dysplasia and sex-determining region Y (SRY) gene, 8 patients with sexual abnormality were analyzed by cytogenetic and molecular genetic methods. Fluorescence in situ hybridization (FISH) using PY3.4, X alpha satellite, and SRY probes was performed in each case to analyze the sex chromosome translocation and gene translocation. SRY gene was amplified by polymerase chain reaction (PCR) and its mutation was detected by direct sequencing. The results showed that among 8 patients, 5 were positive for SRY and the remaining negative for SRY. In the patients positive for SRY genes, 3 presented testes and the left 2 streak ovaries. In the patients negative for SRY, only one case presented testes, while 2 ovaries. Direct sequencing demonstrated that all SRY genes were normal in the patients positive for SRY genes. FISH technique demonstrated that SRY genes translocated from Ypter to Xpter in 2 46,XX phenotypic males positive for SRY genes. It was concluded that SRY gene is strongly involved in male sex determination, while a sequence of other genes may be taken into account in sexual development.
Genes, sry/*genetics ; Gonadal Dysgenesis, 46,XX/genetics ; Gonadal Dysgenesis, 46,XY/genetics ; Sex Chromosome Disorders/*genetics ; Sex-Determining Region Y Protein/*genetics

In order to investigate the relationship between sex dysplasia and sex-determining region Y (SRY) gene, 8 patients with sexual abnormality were analyzed by cytogenetic and molecular genetic methods. Fluorescence in situ hybridization (FISH) using PY3.4, X alpha satellite, and SRY probes was performed in each case to analyze the sex chromosome translocation and gene translocation. SRY gene was amplified by polymerase chain reaction (PCR) and its mutation was detected by direct sequencing. The results showed that among 8 patients, 5 were positive for SRY and the remaining negative for SRY. In the patients positive for SRY genes, 3 presented testes and the left 2 streak ovaries. In the patients negative for SRY, only one case presented testes, while 2 ovaries. Direct sequencing demonstrated that all SRY genes were normal in the patients positive for SRY genes. FISH technique demonstrated that SRY genes translocated from Ypter to Xpter in 2 46,XX phenotypic males positive for SRY genes. It was concluded that SRY gene is strongly involved in male sex determination, while a sequence of other genes may be taken into account in sexual development.
Female ; Genes, sry ; genetics ; Gonadal Dysgenesis, 46,XX ; genetics ; Gonadal Dysgenesis, 46,XY ; genetics ; Humans ; Male ; Sex Chromosome Disorders ; genetics ; Sex-Determining Region Y Protein ; genetics

OBJECTIVETo investigate the phenotype, pathogenesis and molecular biological features of 46, XX testicular disorder of sex development.

METHODSWe obtained the history of 2 patients with 46, XX testicular disorder of sex development, examined the cavitas pelvis by type-B ultrasonography, analyzed the karyotype of the chromosome, and detected the genes SRY, YRRM1, DYS240 and DAZ by PCR amplification.

RESULTSMicrorchidia, azoospermia and maldevelopment of secondary sex characteristics were observed in both of the patients, but ultrasonography revealed no female internal genitals. Their chromosome gender was karyotyped as 46, XX, with the SRY gene positive in both, but the YRRM1 gene positive in only one of the cases.

CONCLUSIONChromosome karyotyping and detection of the SRY gene for patients with abnormal sex development can give us an insight into the genetic pathogenesis and provide us with scientific evidence for the diagnosis and treatment of the condition.

Adult ; Genes, sry ; Gonadal Dysgenesis, 46,XX ; genetics ; Humans ; Male ; Nuclear Proteins ; genetics ; RNA-Binding Proteins ; genetics

PURPOSE: Feminizing genitoplasty is the surgical management after female gender assignment for intersex patients. The surgical outcome and complications of 20 cases of feminizing genitoplasty were analyzed. MATERIALS AND METHODS: Between January 1988 and December 2003, 20 patients surgically treated by feminizing genitoplasty, were retrospectively reviewed. The mean ages at the time of diagnosis and surgical treatment were 6.25 and 7.35 years, respectively. The preoperative evaluations included history taking, physical examination, and chromosomal, hormonal, and radiological studies. All patients underwent feminizing genitoplasty, including at least one of clitoral reconstruction, vaginoplasty or labial reconstruction. The 20 patients were analyzed according to their karyotype, phenotype, gender of rearing, ages at diagnosis and operation, surgical procedures, complications and follow up. RESULTS: Of the 20 cases, there were 10 female pseudohermaphroditism, 6 male pseudo- hermaphroditism, 3 gonadal dysgenesis, and 1 Mayer- Rokitanski-Kuster syndrome. Within these cases, 14, 10 and 9 clitoral reconstructions, vaginoplasties and labial reconstructions were performed. The streak gonad was removed in all patients with gonadal dysgenesis. Postoperative cosmetic and functional effects were successful, with few complications. CONCLUSIONS: Considering our surgical outcomes, feminizing genitoplasty for intersex patients, who are determined to a female gender assignment, is a good surgical procedure.
46, XX Disorders of Sex Development ; Diagnosis ; Disorders of Sex Development ; Female ; Follow-Up Studies ; Gonadal Dysgenesis ; Gonads ; Humans ; Karyotype ; Male ; Phenotype ; Physical Examination ; Retrospective Studies ; Surgery, Plastic

PURPOSE: A change in gender assignment after 2 years of age is associated with severe psychological problems for the child and family. It is important that a definitive diagnosis be determined as quickly as possible. The treatment of ambiguous genitalia will be different by individual difference. We reviewed 16 cases of ambiguous genitalia patients with the object of encouraging early diagnosis and proper treatment individually. MATERIALS AND METHODS: We reviewed retrospectively 16 patients with ambiguous genitalia who were surgically managed at our department. Diagnostic workup included chromosomal analysis, blood and urine steroid measurement, hormonal study and radiologic study. The patients consisted of female pseudohermaphroditism in five cases, male pseudohermaphroditism in nine cases, true hermaphroditism and mixed gonadal dysgenesis in one case in each. The groups were analyzed according to karyotype, sex of rearing, age at diagnosis, age at operation, op procedure, post op complication and follow up. RESULTS: Five cases of female pseudohermaphroditism were raised as female in three cases and male in two cases, re-assigned and surgically corrected as four females and one male. Nine cases of male pseudohermaphroditism were raised as female in six cases and male in three cases, re-assigned and surgically corrected as three females and six males. One case of true hermaphroditism was surgically corrected as male. One case of mixed gonadal dysgenesis was surgically corrected as female and then given hormonal therapy. Four patients had sex conversion after 2 years of age. CONCLUSIONS: Though early diagnosis and treatment are most important, most patients were diagnosed and treated after 2 years of age. A continuous effort should be made to educate parents and alert attending physicians so that early diagnosis and treatment of these patients could be made as soon as possible.
46, XX Disorders of Sex Development ; 46, XY Disorders of Sex Development ; Child ; Diagnosis ; Disorders of Sex Development* ; Early Diagnosis ; Female ; Follow-Up Studies ; Gonadal Dysgenesis, Mixed ; Humans ; Individuality ; Karyotype ; Male ; Ovotesticular Disorders of Sex Development ; Parents ; Retrospective Studies

During the last 6.5 years 49 patients with inter sex were managed at the Department of Urology, Seoul National University Hospital. The median age was 8.8 years (from 2 months to 37 years). The patients consist of 15 female pseudohermaphroditism (adrenogenital syndrome), 4 true hermaphroditism, 21 male pseudohermaphroditism, 3 mixed gonadal dysgenesis, 3 Turner`s syndrome and 3 miscellaneous inter sex including Smith-Lemli-Opitz syndrome and Prader-Willi syndrome. Though early diagnosis and treatment are most important, only 10 patients (20%) were diagnosed before 2.5 years of age.
46, XX Disorders of Sex Development ; 46, XY Disorders of Sex Development ; Disorders of Sex Development* ; Early Diagnosis ; Gonadal Dysgenesis, Mixed ; Humans ; Ovotesticular Disorders of Sex Development ; Prader-Willi Syndrome ; Seoul ; Smith-Lemli-Opitz Syndrome ; Urology

A chromosomal study was performed in a tota1 of 98 patients with suspected Y chromosomal abnormalities during past 1-1/2 years (Feb. 1984 -Aug. 1985). Karyotypes were obtained using short-term blood culture. Of these 43 (44%) patients had abnormal chromosome complements. Among all patients with chromosome abnormalities, 88% (38/43) had aberrations of chromosome number and others 32% (5/42) had aberrations of chromosome structure. The results of chromosomal study in various groups showed as follows: l. In 34 cases of Klinefelter's syndrome, there were 31 cases (91%) of 47,XXY, 1 case of 46,XX,47, XXY, 1 case of 48, XXXXY and 1 case of 46,XX/46,XY/47,XXY. 2. AII 3 cases of mixed gonadal dysgenesis had 45,X/46,XY. 3. l case of true hermaphroditism had 46,XX. 4. Z cases of male Turner`s syndrome, 6 cases of male pseudohermaphroditism and 1 case of agonadism had 46,XY. 5. In 6 cases of female pseudohermaphroditism, there were 4 cases of 46,XX, 1 case of 46,XX, inv(9) and 1 case of 46,XX, t (14q, 21q). 6. In 28 cases of hypogonadism (excluding Klinefelter`s syndrome), there were 25 cases (89%) of 46, XY, 1 case of 46,XY, 15s-, 1 case of 46,XY, inv(9) and 1 case of 46,XY/46, XY,t(7 : 14). 7. 1 case of cryptorchism had 47,XY,+21. 8. All of 5 cases of hypospadia, 5 cases of cryptorchism, 3 cases of hypospadia with cryptorchism, 2 cases of small phallus, 1 case of concealed penis and 1 case of normal male who wanted to correct his registered sex had 46,XY.
46, XX Disorders of Sex Development ; 46, XY Disorders of Sex Development ; Chromosome Aberrations* ; Chromosome Structures ; Complement System Proteins ; Cryptorchidism ; Cytogenetics* ; Down Syndrome ; Female ; Gonadal Dysgenesis, Mixed ; Humans ; Hypogonadism ; Hypospadias ; Karyotype ; Klinefelter Syndrome ; Male ; Ovotesticular Disorders of Sex Development ; Penis ; Y Chromosome

It is well known that proper gender assignment and treatment to a neonate born with ambiguous genitalia are extremely important. We reviewed seven patients with ambiguous genitalia who were surgically managed at our department during recent 5 years. The median age was 12.1 years (from 3 to 24 years) and patients consist of three female pseudohermaphroditism (adrenogenital syndrome), one true hermaphroditism, one male pseudohermaphroditism and two mixed gonadal dysgenesis. Three patients were managed with clitoral recession and vaginoplasty, each of them with clitoral recession vaginoplasty and gonadectomy, with clitoral recession and gonadectomy, with clitoral recession, with gonadectomy and bilateral mastectomy. One patient with adrenogenital syndrome was raised as male, but re-assigned and surgically corrected as female at her age of 16 years. Another one patient with true hermaphroditism was raised as male who underwent excision of female internal genitalia, gonadectomy and bilateral mastectomy in considering of patient's gender identity, appearance of external genitalia and parent's proposal although the karyotype was 46 XX. We suggest that gender assignment and surgical correction must be done as early as possible after full evaluation of fertility feasibility, karyotype, sex ability and patient and parent's proposal.
46, XX Disorders of Sex Development ; 46, XY Disorders of Sex Development ; Adrenogenital Syndrome ; Disorders of Sex Development* ; Female ; Fertility ; Gender Identity ; Genitalia ; Gonadal Dysgenesis, Mixed ; Humans ; Infant, Newborn ; Karyotype ; Male ; Mastectomy ; Ovotesticular Disorders of Sex Development

BACKGROUND: Abnormal sex differentiation and development may present ambiguous genitalia in the newborn or lack of secondary sexual characteristics in puberty. A prompt and accurate diag-nosis should be established to minimize or avoid medical, psychological and social complications. The purpose of this study was to evaluate the causes and clinical characteristics of patients with abnormal sex differentiation and development. METHODS: We analyzed 35 patients with abnormal sex differentiation and development. Twenty patients had been considered or reared as males and fifteen patients as females. The diagnostic evaluation consisted of physical examination, hormonal analysis, sonogram, genitogram, gonadal biopsy and cytogenetics. RESULTS: Among the thirty-five patients, 11 patients were hypogonadism, 9 male pseudoherma-phroditism (5 hypospadia, 2 androgen insensitivity syndrome), 6 female pseudohermaphroditism (4 congenital adrenal hyperplasia), 4 micropenis, 4 congenital anomaly and 1 mixed gonadal dys-genesis. Gonadectomy was performed in patients with androgen insensitivity syndrome and mixed gonadal dysgenesis. Sex of rearing and gender assignment were all concordant with the known sex except one patient, who was previously reared as female and finally reassigned as male due to 5-alpha reductase deficiency. CONCLUSIONS: The causes of abnormal sex differentiation and development were variable. There-fore, an accurate diagnosis should be made by history, physical examination, radiologic and laboratory tests. Proper management and sex assignment are needed in accordance with the cause.
46, XX Disorders of Sex Development ; Adolescent ; Amenorrhea ; Androgen-Insensitivity Syndrome ; Biopsy ; Cytogenetics ; Diagnosis ; Disorders of Sex Development ; Female ; Gonadal Dysgenesis, Mixed ; Gonads ; Humans ; Hypogonadism ; Hypospadias ; Infant, Newborn ; Male ; Oxidoreductases ; Physical Examination ; Puberty ; Sex Differentiation* ; Sexual Development