Mutational Analysis of Androgen Receptor (AR) Gene in 46XY Patients withAmbiguous Genitalia and Normal Testosterone Secretion: Endocrinological Characteristics ofThree Patients with AR Gene Mutations

摘要

The prevalence of abnormalities in androgen receptor gene (AR) among patients with ambiguous genitalia is unknown. Moreover, endocrinological data from prepubertal patients with AR mutation are very limited. Thus, the aim of this study was to examine the prevalence of abnormalities in AR among patients with both ambiguous genitalia, which was defined as a combination of two or more genital abnormalities (i.e. hypospadias, microphallus (penile length < 25 mm), hypoplastic scrotum, bifid scrotum, undescended testis) in this study, and normal to elevated T levels. We also compared the endocrinological data of prepubertal patients with AR mutation and ambiguous genitalia with that of those without the AR mutation. We screened 26 Japanese prepubertal 46,XY patients (five from three families were included) with both ambiguous genitalia and normal to elevated T levels. Mutations in AR were found in three (two of the three were related). Among the 23 patients without mutation in AR, the steroid 5-alpha-reductase 2 gene (SRD5A2) was also examined in eight patients with elevated T/dehydrotestosterone ratio after the hCG (>10) or with undervirilized family members. No mutation in SRD5A2 was found. Characteristics of the three patients with mutation in AR were compared with the 23 patients without mutation. In two patients, basal T levels (0.3, 0.2 ng/ml) and peak T levels after the hCG tests (8.3, 8.5 ng/ml) tended to be higher, and the peak LH/ peak FSHratios after the GnRH tests (4.6, 4.0) were higher than in patients without mutation, atthe ages of 1 yr and 9 mo and 3 yr and 8 mo, respectively. In conclusion, an abnormalityin either AR or SRD5A2 was not common among patients with ambiguous genitalia and normaltestosterone secretion. Elevated peak LH/peak FSH ratio (≥4) after the GnRH test inaddition to detectable basal T levels and elevated peak T levels after the hCG test mayinfer AR abnormality in prepubertal patients with ambiguous genitalia at the age of oneand over, although further study is needed, because our data were limited.