Hallazgos cromosómicos y del gen SRY por FISH en pacientes con trastornos del desarrollo sexual
DOI:
https://doi.org/10.48193/revistamexicanadeurologa.v81i3.711Palabras clave:
Trastornos del desarrollo sexual, cariotipo, FISH, gen SRY, Mosaico cromosómico, cromosoma Y isodicéntricoResumen
Objective
Disorders of sexual development are a group of congenital diseases that affect the normal formation of genital structures. Within the pathophysiologic mechanisms described, there are genetic factors caused by chromosomal or sex-determining gene alterations. Therefore, chromosomal analysis is an essential priority in the diagnostic approach. Alterations in the chromosomes and the SRY gene as a cause of disorder of sexual development was analyzed herein.
Material and methods
G or R-banding karyotype and FISH analyses for the SRY gene were performed in lymphocytes, gonadal tissue, and scrotal tissue in twelve cases, three cases, and one case, respectively. The clinical information was obtained from the patients’ medical reports.
Results
In 9 (73%) cases, the assigned sex was male, and in 3 (27%) cases, it was female. Karyotype 46,XY was found in 8 (66%) cases, 46,XX in 2 (17%) cases, and mosaic karyotype in 2 (17%) cases with idic(Y). A single case of gonadal tissue showed mosaicism due to the presence of a tetraploid cell line. The most common clinical diagnosis was abnormal genital differentiation in 8 (67%) cases, followed by hypospadias in 5 (41.7%) cases.
Conclusions
The results show the importance of applying different cytogenetic tests in making the diagnosis, and the need for a multidisciplinary team to address the disorder.
Referencias
García-Acero M, Moreno O, Suárez F, Rojas A. Disorders of Sexual Development: Current Status and Progress in the Diagnostic Approach. CUR. 2019;13(4):169–78. doi: 10.1159/000499274
Hughes IA. Disorders of sex development: a new definition and classification. Best Pract Res Clin Endocrinol Metab. 2008;22(1):119–34. doi: 10.1016/j.beem.2007.11.001
Achermann J, Hughes IA. Sexual Dysfunction in Men and Women. In: Williams Texbook of Endocrinology. 13th ed. 2016. p. 785–830.
Eid W, Biason-Lauber A. Why boys will be boys and girls will be girls: Human sex development and its defects. Birth Defects Research Part C: Embryo Today: Reviews. 2016;108(4):365–79. doi: https://doi.org/10.1002/bdrc.21143
Zarante I, Franco L, López C, Fernández N. Frequencies of congenital malformations: assessment and prognosis of 52,744 births in three cities of Colombia. Biomédica. 2010;30(1):65–71. doi: 10.7705/biomedica.v30i1.154
Brain CE, Creighton SM, Mushtaq I, Carmichael PA, Barnicoat A, Honour JW, et al. Holistic management of DSD. Best Pract Res Clin Endocrinol Metab. 2010;24(2):335–54. doi: 10.1016/j.beem.2010.01.006
Mouriquand PDE, Gorduza DB, Gay C-L, Meyer-Bahlburg HFL, Baker L, Baskin LS, et al. Surgery in disorders of sex development (DSD) with a gender issue: If (why), when, and how? J Pediatr Urol. 2016;12(3):139–49. doi: 10.1016/j.jpurol.2016.04.001
Fernandez N, Moreno O, Rojas A, Céspedes C, Forero C, Mora L, et al. Manejo transdisciplinario de pacientes con desórdenes del desarrollo sexual en Colombia. Limitantes para un manejo oportuno e integral. Urología Colombiana. 2017;26(3):164–8. doi: 10.1016/j.uroco.2016.06.004
Achermann JC, Domenice S, Bachega TASS, Nishi MY, Mendonca BB. Disorders of sex development: effect of molecular diagnostics. Nat Rev Endocrinol. 2015;11(8):478–88. doi: 10.1038/nrendo.2015.69
Witchel SF. Disorders of sex development. Best Pract Res Clin Obstet Gynaecol. 2018;48:90–102. doi: 10.1016/j.bpobgyn.2017.11.005
Clouston H. Lymphocyte culture. In: Human Cytogenetics constitutional analyses. 3rd ed. London: Rooney DE Editor; 2001.
McGowan-Jordan J, Simons A, Schmid M, Karger S. ISCN 2016 | Karger Book. 2016. [accessed 3 Jun 2021] Available from: https://www.karger.com/Book/Home/271658
Olshan J, Eimicke T, Belfort E. Gender Incongruity in Children With and Without Disorders of Sexual Differentiation. Endocrinol Metab Clin North Am. 2016;45(2):463–82. doi: 10.1016/j.ecl.2016.02.001
Rodriguez-Buritica D. Overview of genetics of disorders of sexual development. Curr Opin Pediatr. 2015;27(6):675–84. doi: 10.1097/MOP.0000000000000275
García-Acero M, Molina M, Moreno O, Ramirez A, Forero C, Céspedes C, et al. Gene dosage of DAX-1, determining in sexual differentiation: duplication of DAX-1 in two sisters with gonadal dysgenesis. Mol Biol Rep. 2019;46(3):2971–8. doi: 10.1007/s11033-019-04758-y
Kashimada K, Koopman P. Sry: the master switch in mammalian sex determination. Development. 2010;137(23):3921–30. doi: 10.1242/dev.048983
McClelland K, Bowles J, Koopman P. Male sex determination: insights into molecular mechanisms. Asian J Androl. 2012;14(1):164–71. doi: 10.1038/aja.2011.169
Farrugia MK, Sebire NJ, Achermann JC, Eisawi A, Duffy PG, Mushtaq I. Clinical and gonadal features and early surgical management of 45,X/46,XY and 45,X/47,XYY chromosomal mosaicism presenting with genital anomalies. J Pediatr Urol. 2013;9(2):139–44. doi: 10.1016/j.jpurol.2011.12.012
Chang HJ, Clark RD, Bachman H. The phenotype of 45,X/46,XY mosaicism: an analysis of 92 prenatally diagnosed cases. Am J Hum Genet. 1990;46(1):156–67.
Abacı A, Çatlı G, Berberoğlu M. Gonadal malignancy risk and prophylactic gonadectomy in disorders of sexual development. J Pediatr Endocrinol Metab. 2015;28(9–10):1019–27. doi: 10.1515/jpem-2014-0522
Huang H, Wang C, Tian Q. Gonadal tumour risk in 292 phenotypic female patients with disorders of sex development containing Y chromosome or Y-derived sequence. Clin Endocrinol (Oxf). 2017;86(4):621–7. doi: 10.1111/cen.13255
Guedes AD, Bianco B, Lipay MVN, Brunoni D, Chauffaille M de L, Verreschi ITN. Determination of the sexual phenotype in a child with 45,X/46,X,Idic(Yp) mosaicism: Importance of the relative proportion of the 45,X line in gonadal tissue. American Journal of Medical Genetics Part A. 2006;140A(17):1871–5. doi: https://doi.org/10.1002/ajmg.a.31363
Acero MG, Moreno O, Gutiérrez A, Sánchez C, Cataño JG, Suárez-Obando F, et al. Novel homozygous mutation in a colombian patient with persistent müllerian duct syndrome: expanded phenotype. Int Braz J Urol. 2019;45(5):1064–70. doi: 10.1590/S1677-5538.IBJU.2018.0808