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Review
. 2019 Apr 9;16(7):1268.
doi: 10.3390/ijerph16071268.

Different Clinical Presentations and Management in Complete Androgen Insensitivity Syndrome (CAIS)

Lucia Lanciotti  1 , Marta Cofini  2 , Alberto Leonardi  3 , Mirko Bertozzi  4 , Laura Penta  5 , Susanna Esposito  6
Affiliations
Review

Different Clinical Presentations and Management in Complete Androgen Insensitivity Syndrome (CAIS)

Lucia Lanciotti et al. Int J Environ Res Public Health. .

Abstract

Complete androgen insensitivity syndrome (CAIS) is an X-linked recessive genetic disorder resulting from maternally inherited or de novo mutations involving the androgen receptor gene, situated in the Xq11-q12 region. The diagnosis is based on the presence of female external genitalia in a 46, XY human individual, with normally developed but undescended testes and complete unresponsiveness of target tissues to androgens. Subsequently, pelvic ultrasound or magnetic resonance imaging (MRI) could be helpful in confirming the absence of Mullerian structures, revealing the presence of a blind-ending vagina and identifying testes. CAIS management still represents a unique challenge throughout childhood and adolescence, particularly regarding timing of gonadectomy, type of hormonal therapy, and psychological concerns. Indeed this condition is associated with an increased risk of testicular germ cell tumour (TGCT), although TGCT results less frequently than in other disorders of sex development (DSD). Furthermore, the majority of detected tumoral lesions are non-invasive and with a low probability of progression into aggressive forms. Therefore, histological, epidemiological, and prognostic features of testicular cancer in CAIS allow postponing of the gonadectomy until after pubertal age in order to guarantee the initial spontaneous pubertal development and avoid the necessity of hormonal replacement therapy (HRT) induction. However, HRT is necessary after gonadectomy in order to prevent symptoms of hypoestrogenism and to maintain secondary sexual features. This article presents differential clinical presentations and management in patients with CAIS to emphasize the continued importance of standardizing the clinical and surgical approach to this disorder.

Keywords: complete androgen insensitivity syndrome; disorders of sex development; hormonal replacement therapy; testicular germ cell tumour.

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Conflict of interest statement

The authors declare that the review was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Androgen receptor gene and protein.
Figure 2
Figure 2
Genealogical tree of the family.
See this image and copyright information in PMC

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MeSH terms

Supplementary concepts