Molecular genetics and phenotype/genotype correlation of 5-reductase deficiency in a highly consanguineous population

Context and objectives5- reductase deficiency is a rare 46,XY disorder of sex development. We present detailed phenotypic and genotypic features of a cohort of 24 subjects from a highly consanguineous population of Saudi ArabiaSubjects and MethodsWe studied the clinical presentation and hormonal profiles of 24 subjects diagnosed with 5- reductase deficiency and performed genetic testing on DNA isolated from their peripheral blood using polymerase chain reaction and direct sequencing of the SRD5A2.ResultsAll subjects had 46,XY karyotype and presented with atypical appearance of external genitalia ranging from clitoromegaly, micophallus with hypospadias, undescended testes to completely normally looking female genitalia. Thirteen (54%) of them had severe under virilization and were assigned female sex at birth. The other 11 subjects were raised as males. Stimulated Testosterone:Dihydrotestosterone ratio was high in all 16 subjects in whom it was measured. The genetic testing revealed 2 nonsense mutations (p.R103X and p.R227X) in 2 unrelated subjects, 3 missense mutations (p.P181L, p.A228T, p.R246Q) in 11 subjects and a splice site mutation (IVS1-2A>G) in 11 other subjects. There was significant phenotypic variability even in subjects with the same mutation and also within the same family.ConclusionThis is the first and largest report of the clinical and molecular genetics of 5- reductase deficiency from the Middle East. It shows weak genotype/phenotype correlation and significant phenotypic heterogeneity. IVS1-2A>G mutation is the most common mutation and is likely to be a founder mutation in this part of the world.