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Androgen insensitivity syndrome: a survey of diagnostic procedures and management in the UK
R M Viner1, Y Teoh, D M Williams
1Department of Paediatrics, University of Cambridge, Addenbrookes Hospital.
Objective:
A two year survey of androgen insensitivity syndrome (AIS) to assess current diagnostic and management strategies.
Methods:
Cases were ascertained by inclusion on the British Paediatric Surveillance Unit monthly report card for 24 months.
Results:
Fifty one of 139 notifications were confirmed as AIS; 29 cases were complete AIS and 22 cases partial AIS. Seventy six per cent of complete AIS presented with an inguinal hernia, and half the complete AIS patients had an established family history of the disorder. Presentation in the partial AIS group was through ambiguous or undermasculinised genitalia; 59% of partial AIS were raised as male.
Conclusions:
The importance of karyotyping girls with inguinal hernias is confirmed, and further attention should be given to genetic counselling for families of complete AIS patients. A large number of cases were misreported as partial AIS, emphasising the importance of undertaking a comprehensive diagnostic evaluation in intersex states. A large percentage of children with partial AIS were raised as boys despite severe genital undermasculinisation, indicating the current lack of validated measures that predict genital response to androgen treatment. The management of AIS is discussed and diagnostic guidelines provided to improve the diagnostic yield in AIS.