Disorders of sexual differentiation (DSDs) have been defined as “congenital conditions in which development of chromosomal, gonadal, or anatomic sex is atypical”.
Types
disorders of genital differentiation (disorders generally associated with a normal chromosome constitution and normal gonad)
- FEMALE PSEUDOHERMAPHRODITISM (FEMALE INTERSEX)
- Fetal defect
- Adrenogenital syndrome (testosterone overproduction due to adrenocorticoid insuffi ciency)
- 21α-Hydroxylase defi ciency
- 11β-Hydroxylase defi ciency
- Placental aromatase defect
- Adrenogenital syndrome (testosterone overproduction due to adrenocorticoid insuffi ciency)
- Maternal infl uence
- Maternal ingestion of progestins or androgens
- Maternal virilizing tumor
- Fetal defect
- MALE PSEUDOHERMAPHRODITISM (MALE INTERSEX)
- Primary gonadal defects
- Testicular regression syndrome (gonadal destruction)
- Leydig cell agenesis
- Defective hCG-LH receptor
- Defects in testosterone synthesis
- Testosterone and adrenocorticoid insufficiency
- Defect in cholesterol synthesis (Smith–Lemli–Opitz syndrome)
- 20,22-Desmolase defi ciency (StAR deficiency)
- 3β-Hydroxylase dehydrogenase deficiency
- 17α-Hydroxylase deficiency
- Testosterone insufficiency only
- 17,20-Desmolase defi ciency
- 17β-Hydroxysteroid (17-ketosteroid reductase) dehydrogenase defi ciency
- Persistent müllerian duct syndrome (defect in müllerian inhibiting substance system)
- Testosterone and adrenocorticoid insufficiency
- End-organ defects
- Androgen receptor binding deficiency
- Androgen insensitivity syndrome (testicular feminization)
- Incomplete androgen insensitivity syndrome (Reifenstein syndrome)
- Peripheral androgen transformation defi ciency
- 5α-Reductase deficiency
- Androgen receptor binding deficiency
- Primary gonadal defects
disorders of sex determination (disorders generally associated with an abnormal sex chromosome constitution leading to abnormal gonadal formation)
- SEXUAL AMBIGUITY INFREQUENT
- Klinefelters syndrome (XXY)
- Turners syndrome and Turner-like (XO and X mosaicism)
- XX male (sex reversal)
- Pure gonadal dysgenesis, bilateral
- Disorders of Wilms tumor gene (WT1)
- Denys–Drash syndrome
- Frasiers syndrome
- SEXUAL AMBIGUITY INFREQUENT
- XY disorder of sex development (DSD) (mixed gonadal dysgenesis (MGD)), including
- Turner-like (some forms)
- Dysgenetic male pseudohermaphroditism
- XY male to female sex reversal
- Steroidogenic Factor 1 (SF1) abnormality
- Deleted chromosome 9p
- True hermaphroditism
- XY disorder of sex development (DSD) (mixed gonadal dysgenesis (MGD)), including
Phenotypes
Female pseudohermaphroditism (46,XX DSD) causes a female genotype and two ovaries for gonads, but their external genitalia show a variable degree of virilization.
Male pseudohermaphroditism (46,XY DSD) causes a male genotype and two testes for gonads, but their external genitalia show a variable degree of feminization.
True hermaphrodites (ovotesticular DSD) causes both testicular and ovarian tissues in the gonads.
In patients with pure gonadal dysgenesis (PGD), both gonads are streak gonads (ie, dysfunctional gonads without germ cells). Patients with mixed gonadal dysgenesis (MGD) have a testis on one side and a streak gonad on the other.
Chromosomal classifcation
Morphological classification
true hermaphrodism
MGD
pseudohermaphroditisms
- male pseudohermaphroditism
- female pseudohermaphroditism
Etiology
chromosomal diseases
monogenic diseases
caudal regression syndrome
Nomenclature
A new nomenclature for disorders of sexual differentiation has been proposed by the International Consensus Conference on Intersex (organized by the Lawson Wilkins Pediatric Endocrine Society) and the European Society for Pediatric Endocrinology, and takes into consideration developments in molecular genetics, ethical issues, and the perception of existing terms as potentially pejorative.
The term disorders of sex development (DSDs) was proposed to describe the entire group. The consensus group proposed the classification of DSDs into:
sex chromosome DSDs
46,XY DSDs
46,XX DSDs
Case records
Case 10645: caudal regression syndrome with lumbosacral agenesis
See also
Reviews (Biology)
MacLaughlin DT, Donahoe PK. Sex determination and differentiation. N Engl J Med. 2004 Jan 22;350(4):367-78. PMID: 14736929
Vaiman D, Pailhoux E. Mammalian sex reversal and intersexuality: deciphering the sex-determination cascade. Trends Genet. 2000 Nov;16(11):488-94. PMID: 11074290
Behrman: Nelson Textbook of Pediatrics, 16th ed., Chapter 598 - Hermaphroditism (Intersexuality), p. 1760-1767.
Cotinot C, Pailhoux E, Jaubert F, Fellous M. Molecular Genetics of Sex Determination, Seminars in Reproductive Medicine, 2002; p. 157-168.
Hutcheson J. Ambiguous Genitalia and Intersexuality, eMedicine Journal, 2002, 3(8); p.1-25.
McGregor L et al. Fraser syndrome and mouse blebbed phenotype caused by mutations in FRAS1/Fras1 encoding a putative extracellular matrix protein, Nature Genetics, 2003, 34(2); p. 203-208.
Sultan C, Paris F, Jeandel C, Lumbroso S, Benoît Galifer R. Ambiguous Genitalia in the Newborn, Seminars in Reproductive Medicine, 2002; p. 181-188.
References
New insights into type II germ cell tumor pathogenesis based on studies of patients with various forms of disorders of sex development (DSD). Hersmus R, de Leeuw BH, Wolffenbuttel KP, Drop SL, Oosterhuis JW, Cools M, Looijenga LH. Mol Cell Endocrinol. 2008 Sep 10;291(1-2):1-10. PMID: 18403106
NabhanZM, Lee PA. Disorders of sex development. Curr Opin Obstet Gynecol 2007;19:440–445.
JhaA. Intersex (genital ambiguity). Available at: http://www.bui.ac.uk/Tutorials/Inte.... Accessed October 1, 2007.
LooijengaLH, Hersmus R, Oosterhuis JW, Cools M, Drop SL, Wolffenbuttel KP. Tumor risk in disorders of sex development (DSD). Best Pract Res Clin Endocrinol Metab 2007;21:480–495.
Books
Oxford Medical Databases
London Dysmorphology Database
Potter’s Pathology of the Fetus and Infant, Chapter 27 - Reproductive System, editor Enid Gilbert-Barness, p. 1202-1241.
Walsh: Campbell’s Urology, 8th ed., Chapter 68 - Sexual Differentiation: Normal and Abnormal, 2002, p. 2395-2423.