ESPE2022 Poster Category 1 Sex Differentiation, Gonads and Gynaecology, and Sex Endocrinology (56 abstracts)
Gynaecomastia And Its Management In Partial Androgen Insensitivity Syndrome (PAIS)
Supitcha Patjamontri 1,2 , Angela Lucas-Herald 1 , Jillian Bryce 1 , Martine Cools 3 , Russo Gianni 4 , Evgenia Globa 5 , Natalia Zelinska 5 , Gil Guerra-Junior 6 , Paul-Martin Holterhus 7 , Ieuan A Hughes 8 , Rieko Tadokoro-Cuccaro 8 , Anna Nordenstrom 9 , Marianna Rita Stancampiano 4 , Naomi Weintrob 10 , Erica van den Akker 11 , Olaf Hiort 12 , Paul Hoffman 13 , Anders Juul 14 , Sumudu Nimali Seneviratne 15 & S. Faisal Ahmed 1
1Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Children, Glasgow, United Kingdom; 2Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 3Department of Paediatric Endocrinology, Ghent University Hospital, University of Ghent, Ghent, Belgium; 4Department of Pediatrics, Endocrine Unit, Scientific Institute San Raffaele, Milan, Italy; 5Ukrainian Scientific and Practical Center of Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine, Kyiv, Ukraine; 6Interdisciplinary Group for the Study of Gender Determination and Differentiation (GIEDDS), School of Medical Sciences (FCM), State University of Campinas (UNICAMP), Campinas, Brazil; 7Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Kiel/Christian-Albrechts University of Kiel, Kiel, Germany; 8Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom; 9Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; 10Endocrinology and diabetes unit Dana-Dwek Children's Hospital, Tel Aviv, Israel; 11Division of Pediatric Endocrinology, Department of Pediatrics, Sophia Children's Hospital and center of expertise DSD, Erasmus University Medical Center, Rotterdam, Netherlands; 12Division of Paediatric Endocrinology and Diabetes University of Lübeck, Lübeck, Germany; 13Liggins Institute’s Paykel Clinical Research Unit, University of Auckland, Auckland, New Zealand; 14Growth and Reproduction Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; 15Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
Introduction: In adolescents and men with PAIS, gynaecomastia has been reported in the majority but its management remains challenging.
Objectives: To assess the current management of gynaecomastia as well as clinical characteristics in male PAIS.
Materials and Methods: Retrospective review in the I-DSD registry of 46, XY male PAIS who were over the age of 10 years.
Results: Of the 205 cases in the I-DSD Registry from 26 centres who were over 10 yrs of age, information was available in 64 cases from 13 centres with a median number of cases per centre of 4 (range 1,16). The median age at first presentation was 0.9yrs (0.1,41.0). The median external masculinisation score (EMS) at presentation was 6 (2,12). Of the 64 participants, atypical genitalia were the presenting feature in 40 (63%), an AR variant had been identified in 48 (75%) and gynaecomastia was reported in 49 (77%). Of the 48 AR variant+ve cases, only 5 (10%) had no gynaecomastia at a median age at last presentation of 14.4 yrs (9.2,17.0). On the other hand, 6 of 13 (46%) cases in whom AR analysis had excluded a variant, had no gynaecomastia at a median age of 16.0yrs (13.0,20.0) (P=0.002). Median age at onset of puberty and at time of development of gynaecomastia were 12.0yrs (10.5,14.0) and 13.5yrs (11.0, 29.0), respectively. Median EMS at time of gynaecomastia development was 9 (3,12). In the cases with biochemistry available, serum testosterone was reported to be raised in 17/32 (53%) and LH and FSH were raised in 14/29 (48%) and 9/28 (32%), respectively. Of the 43 cases in whom information was available, 30 (70%) had either undergone surgery or were awaiting surgery (n,3) and 11 of these 30 had a poor response to a wide range of medical therapy. Median age at time of surgery was 16yrs (13,34). Median clinician score for therapy effectiveness was reported as 10 out of 10 (3,10) in those who had undergone surgery compared to 4.5 (1,9) in those who had medical therapy (P<0.001). Of 43 participants, 12 (28%) were reported to have received clinical psychology support and there was one report of gender dysphoria.
Conclusion: Gynaecomastia is common in PAIS but not necessary universal and may present without the typical biochemical signs of AIS. The current data suggest that surgical management may be more effective than medical therapy but there is a need for further systematic studies.
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