Prophylactic gonadectomy in 46 XY females; why, where and when?

Abstract

Objectives: We compared cases of phenotypic female patients who presented with male karyotype and underwent prophylactic gonadectomy.

Case presentation: Five patients with female phenotypes presented in early adulthood with primary amenorrhoea with varying degrees of puberty. One was tall with breast development. Another was very short with clitoromegaly and multiple co-morbidities. The other three had no secondary sexual characteristics. They were examined, after which hormonal profile, karyotyping, ultrasound examination and magnetic resonance imaging were done to assess the site of gonads. Gonadectomy was performed once their 46 XY karyotype was confirmed. Results of histopathological examination of their gonads ranged from dysgenetic gonads to having testicular tissues and malignancy.

Conclusion: Female patients with 46 XY karyotypes require prophylactic gonadectomy performed at different timings depending on diagnosis due to the malignancy risk. Pre-operative assessment is essential to locate the gonads prior to surgery.

Keywords: 46 XY female; androgen insensitivity syndrome; disorder of sexual development (DSD); gonadal dysgenesis; gonadectomy.