The spectrum of 46XY disorders of sex development in a University centre in Saudi Arabia

Background: The term disorders of sex development (DSD) includes congenital conditions in which development of chromosomal, gonadal, or anatomical sex is atypical. The spectrum of the 46XY (DSD) is so broad. In this study, we reviewed the clinical spectrum of a cohort of patients with 46XY DSD in a tertiary institute in the Middle East over two decades. Objective: To define the clinical spectrum of 46XY DSD in a major teaching hospital, Riyadh, Saudi Arabia. Materials and methods: This is a retrospective, case series hospital-based study. The case notes, laboratory investigations, and imaging studies were reviewed for patients with 46XY DSD over a 20 years period (1989-2010) at King Khalid University Hospital, Riyadh, Saudi Arabia. Molecular genetics were not available in all patients. Results: During the period under review; a total of 56 patients were seen with 46XY DSD due to variable etiologies. Androgen insensitivity syndromes (AIS) and 5-alpha-reductase deficiency were among the commonest (44.6%), with multiple siblings involvement within the family. Of these, 16 patients were showing variable degrees of insensitivity ranging between complete (n = 5, 31.2%) and partial (n = 11, 68.8%) insensitivity, whereas in nine patients the diagnosis of 5-alpha-reductase deficiency was entertained based on hormonal studies. Of interest to see was a high number of patients (n = 14, 25%) either with a localized congenital anomalies such as the cloacal anomalies or generalized congenital malformations following the pattern of certain syndromes. Conclusion: A wide spectrum of causes were noted. Androgen insensitivity syndrome was the commonest. In Saudi Arabia, where consanguineous mating is high, 5-alpha-reductase is also a common cause of 46XY DSD.