Why pediatricians need to know the disorders of sex development: experience of 709 cases in a specialized service Please cite this article as: El Beck MS, Germano CW, Barros BA, Andrade JG, Guaragna-Filho G, Paula GB, et al. Why pediatricians need to know the disorders of sex development: experience of 709 cases in a specialized service. J Pediatr (Rio J). 2020;96:607-13. , ☆☆ ☆☆ Study conducted at Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas (FCM), Grupo Interdisciplinar de Estudos da Determinação e Diferenciação do Sexo (GIEDDS), Campinas, SP, Brazil.

Mayra de Souza El Beck Carlos W. Germano Beatriz A. Barros Juliana G.R. Andrade Guilherme Guaragna-Filho Georgette B. Paula Márcio L. Miranda Mara S. Guaragna Helena Fabbri-Scallet Tais N. Mazzola Nilma L. Viguetti-Campos Társis A.P. Vieira Sofia H.V. Lemos-Marini Antonia P. Marques-de-Faria Roberto B. Paiva e Silva Maricilda P. Mello Andréa T. Maciel-Guerra Gil Guerra-Júnior About the authors

Abstract

Objective:

To evaluate, in a sample of patients with disorders of sex development (DSD), data related to the age at referral and their correlation with the initial complaints, gender at referral, defined gender after diagnosis and etiological diagnosis.

Methods:

Retrospective review of the age at the first consultation and the reason for it, initial social gender and gender after the diagnosis, karyotype and etiological diagnosis of all cases treated at a DSD outpatient clinic between 1989 and 2016. Cases that did not involve DSD and DSD diagnoses that do not usually involve ambiguous genitalia, thus not requiring specialized monitoring, were excluded.

Results:

Of the 1793 treated cases, 1139 were diagnosed with some type of DSD. This study excluded 430 cases (272 with Turner's syndrome, 66 with Klinefelter syndrome, and 92 with pure gonadal dysgenesis), thus a total 709 individuals were included. Of these, 82.9% were referred due to ambiguous genitalia; only one-quarter were still in the first month of life, and 6.6% were referred due to pubertal delay, with most of them aged 10 years or older. Of these patients, 68.6% had a diagnosis of XY DSD, 22.4% of XX DSD, and 9% of sex chromosome abnormalities.

Conclusions:

This study presents the largest series in the literature of patients with DSD treated in a single center. The time of referral of the majority of patients with ambiguous genitalia fell short of the ideal, and milder cases of ambiguous genitalia and many with pubertal manifestations were referred even later. The results reinforce the importance of continuing education for professionals who will have the first contact with these patients, mainly pediatricians and neonatologists.

KEYWORDS
Amenorrhea; Karyotype; Genitalia; Hypogonadism; Gender identity

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