ESPE2016 Poster Presentations Gonads & DSD P1 (48 abstracts)
Clinical History and High Prevalence of Gonadal Tumor in 14 Patients with 46 XY Pure Gonadal Dysgenesis
Claire Sechter-Mavel a , Maryse Cartigny b , Graziella Pinto c , Maud Bidet c , Sophie Catteau-Jonard d , Geoffroy Robin d , Didier Dewailly d , Yves Aigrain e , Thomas Blanc e , Yves Morel f , Jacques Weill b , Michel Polak c, & Dinane Samara-Boustani c
aDepartment of Pediatric Endocrinology, Pediatric Medicine, CHU Jean-Minjoz, Besançon, France; bDepartment of Pediatric Endocrinology, Lille University Hospital, Lille, France; cDepartment of Pediatric Endocrinology, Necker Enfants Malades University Hospital, Paris, France; dDepartment of Endocrine Gynaecology and Reproductive Medicine, Lille University Hospital, Lille, France; eDepartment of Pediatric Surgery and Transplantation, Necker Enfants Malades University Hospital, Paris, France; fDepartment of Molecular Endocrinology and Rare Diseases, Biology and Pathology East Center, University of Lyon, Lyon, France; gInserm U1016, University Paris-Descartes, Paris, France
Background: Pure gonadal dysgenesis 46 XY is a rare form of sexual differentiation disorders.
Objective and hypotheses: This study describes the diagnosis circumstances, clinical, biological and radiological presentation, and genetic aetiology of 14 patients with a 46 XY pure gonadal dysgenesis.
Method: It is a retrospective descriptive multicenter study from Necker Hospital (Paris) and Lille university hospitals.
Results: The patients were diagnosed between prenatal period and 21 years, the median age of diagnosis was 16. Nine of the 14 patients had primary amenorrhea, leading to the late diagnosis. Six of the nine patients aged 10 years and older had already breast development, without any functional gonad; all of these patients had gonadal tumor, gonadoblastoma and/or dysgerminoma. One patient was diagnosed because of abdominal pain due to a tumoral syndrome. Eight of the 13 operated patients (61%) had a gonadal tumor (two gonadoblastoma and six dysgerminoma). Six of the eight gonadal tumor (75%) were malignant, all of those patients were asymptomatic. The median age of tumor’s diagnosis was 15 years, and the youngest patient was 2 years 11 months old. Mutation or deletion was found for 5/10 patients, 3/10 (30%) in the coding sequence of the SRY gene, one in the SF1 gene, and one deletion including DMRT1 and DMRT2 genes in the chromosome 9.
Conclusion: Sixty-one percent of the operated patients had gonadal tumor (gonadoblastoma or dysgerminoma), which is more than literature data. Breast development, even normal appearance, is often due to a tumoral hormonal secretion. We should not delay ablation of the gonads in patients with 46 XY pure gonadal dysgenesis. All primary amenorrhea have to be investigated, and a caryotype must be done, even if it seems isolated with a late Tanner stage.
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