END-STAGE RENAL-DISEASE AND PRIMARY HYPOGONADISM ASSOCIATED WITH A 46,XX KARYOTYPE

Objective.-To determine the cause of absent sexual development in a 17-year-old girl with end-stage renal disease. Design.-Case study. Participant.-Seventeen-year-old girl with end-stage renal failure. Interventions.-None. Measurements/Main Results.-The patient had phenotypically normal external female genitalia, mullerian duct hypoplasia, and no ovaries. Her serum gonadotropin levels were in the castrate range at baseline and after gonadotropin-releasing hormone stimulation. Her karyotype, in lymphocytes and cultured fibroblasts, was 46,XX. Analysis of genomic DNA, following polymerase chain reaction-amplication with oligonucleotide primers corresponding to the Y-encoded zinc finger protein ZFY and the testis-determining SRY gene, showed Y chromosome material in a male control but none in the patient. Conclusions.-The results suggest a diagnosis of Frasier syndrome, a disorder characterized by true gonadal dysgenesis and end-stage renal disease occurring in normal phenotypic girls. Although previously reported only in individuals with a 46,XY karyotype, our studies indicate that Frasier syndrome may also occur in 46,XX girls. Delayed puberty is not uncommon in renal failure. This case illustrates the importance of measuring gonadotropin levels in teenage girls with delayed puberty and renal failure, particularly if the origin of the renal disease is obscure.