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Androgen insensitivity syndrome: a survey of diagnostic procedures and management in the UK
  1. R M Vinerb,
  2. Y Teoha,
  3. D M Williamsa,
  4. M N Pattersona,
  5. I A Hughesa
  1. aDepartment of Paediatrics, University of Cambridge, Addenbrookes Hospital, bUniversity College London Hospitals, Great Ormond Street Hospital, and Middlesex Hospital, London
  1. Professor I A Hughes, Department of Paediatrics, Addenbrookes Hospital, Level 8, Box 116, Hills Road, Cambridge CB2 2QQ.

Abstract

OBJECTIVE A two year survey of androgen insensitivity syndrome (AIS) to assess current diagnostic and management strategies.

METHODS Cases were ascertained by inclusion on the British Paediatric Surveillance Unit monthly report card for 24 months.

RESULTS Fifty one of 139 notifications were confirmed as AIS; 29 cases were complete AIS and 22 cases partial AIS. Seventy six per cent of complete AIS presented with an inguinal hernia, and half the complete AIS patients had an established family history of the disorder. Presentation in the partial AIS group was through ambiguous or undermasculinised genitalia; 59% of partial AIS were raised as male.

CONCLUSIONS The importance of karyotyping girls with inguinal hernias is confirmed, and further attention should be given to genetic counselling for families of complete AIS patients. A large number of cases were misreported as partial AIS, emphasising the importance of undertaking a comprehensive diagnostic evaluation in intersex states. A large percentage of children with partial AIS were raised as boys despite severe genital undermasculinisation, indicating the current lack of validated measures that predict genital response to androgen treatment. The management of AIS is discussed and diagnostic guidelines provided to improve the diagnostic yield in AIS.

  • A karyotype is essential infants with suspected hernias

  • Further attention to genetic counselling is needed for complete AIS patients to improve case ascertainment in subsequent generations

  • Management of suspected partial AIS should involve a specific sequence of clinical, radiological, biochemical, and molecular investigations (fig 1)

  • androgen insensitivity syndrome
  • inguinal hernia
  • intersex

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