Clinical review of 95 patients with 46,XX disorders of sex development based on the new Chicago classification

J Pediatr Adolesc Gynecol. 2015 Feb;28(1):6-11. doi: 10.1016/j.jpag.2014.01.106. Epub 2014 Nov 12.


Study objective: The aim of our study was to determine the etiologic distribution of 46,XX disorder of sexual development (DSD) according to the new DSD classification system and to evaluate the clinical features of this DSD subgroup in our patient cohort.

Participants: The evaluation criteria and clinical findings of 95 46,XX patients were described by clinical presentation, gonadal morphology, genital anatomy, associated dysmorphic features, presence during prenatal period with/without postnatal virilization, hormonal characteristics, and presence or absence of steroidogenic defects among 319 patients with DSD.

Results: Types and ratios of each presentation of our 95 patients with 46,XX DSD were as follows: 82 had androgen excess (86.3%): (74 had classical congenital adrenal hyperplasia, 2 had CAH variant possibility of P450-oxidoreductase gene defect), 6 had disorders of ovarian development (6.3%): (1 patient had gonadal dysgenesis with virilization at birth with bilateral streak gonad, 4 patients had complete gonadal dysgenesis, and 1 patient had ovotesticular DSD) and 7 had other 46,XX DSD. Two sisters, who had 46,XX complete gonadal dysgenesis,were diagnosed with Perrault Syndrome with ovarian failure due to streak gonads and associated with sensorineural deafness.

Conclusion: 46,XX DSD are usually derived from intrauterine virilization and CAH is the most common cause of 46,XX DSD due to fetal androgen exposure.

Keywords: 46,XX karyotype; Disorders of sex development; Etiology.

MeSH terms

  • 46, XX Disorders of Sex Development / classification
  • 46, XX Disorders of Sex Development / etiology*
  • Adolescent
  • Adrenal Hyperplasia, Congenital / complications*
  • Adrenal Hyperplasia, Congenital / genetics
  • Chicago
  • Child
  • Child, Preschool
  • Female
  • Genitalia / abnormalities
  • Gonadal Dysgenesis / complications*
  • Gonadal Dysgenesis / genetics
  • Humans
  • Infant
  • Infant, Newborn
  • Ovotesticular Disorders of Sex Development / complications
  • Ovotesticular Disorders of Sex Development / genetics
  • Retrospective Studies
  • Young Adult