Article

A Gender Assessment Team: experience with 250 patients over a period of 25 years.

Division of Genetics and Developmental Medicine, Department of Pediatrics, Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA.
Genetics in Medicine (impact factor: 4.76). 07/2007; 9(6):348-57. DOI:10.1097GIM.0b013e3180653c47
Source: PubMed

ABSTRACT To describe a Gender Assessment Team that has provided a multidisciplinary approach to the diagnosis, medical and surgical treatment, genetic counseling, and psychosocial support of patients with ambiguous genitalia, intersex disorders, and other genital anomalies, collectively termed disorders of sex development; and to determine the major diagnostic categories and approach.
A retrospective review of 250 patients evaluated by the Team at Children's Hospital and Regional Medical Center in Seattle, WA, from January 1981 through December 2005. The Team included the following specialties: medical genetics, cytogenetics, gynecology, pediatric urology, endocrinology, and psychiatry.
Of the subjects, 177 were infants, 46 were children or adolescents, and 27 had a multisystem genetic condition. The most common diagnoses were congenital adrenal hyperplasia (14%), androgen insensitivity syndrome (10%), mixed gonadal dysgenesis (8%), clitoral/labial anomalies (7%), hypogonadotropic hypogonadism (6%), and 46,XY small-for-gestational-age males with hypospadias (6%).
The six most common diagnoses comprised 50% of the cohort. The expertise of a multidisciplinary team allowed for integrated care for patients with disorders of sex development and identification of novel conditions. Geneticists play an important role in a team approach through knowledge of genetic testing options and diagnosis of patients with karyotypic abnormalities and syndromes with genital anomalies.

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    Article: Female external genitalia on fetal magnetic resonance imaging.
    S F Nemec, U Nemec, M Weber, S Rotmensch, P C Brugger, G Kasprian, C R Krestan, D L Rimoin, J M Graham, D Prayer
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    ABSTRACT: To characterize the normal development of the female external genitalia on fetal magnetic resonance imaging (MRI). This retrospective study included MRI examinations of 191 female fetuses (20-36 gestational weeks) with normal anatomy or minor abnormalities, following suspicion of anomalies on prenatal ultrasound examination. Using a 1.5-Tesla unit, the bilabial diameter was measured on T2-weighted sequences. Statistical description, as well as correlation and regression analyses, was used to evaluate bilabial diameter in relation to gestational age. MRI measurements were compared with published ultrasound data. The morphological appearance and signal intensities of the external genitalia were also assessed. Mean bilabial diameters, with 95% CIs and percentiles, were defined. The bilabial diameter as a function of gestational age was expressed by the regression equation: bilabial diameter = - 11.336 + 0.836 × (gestational age in weeks). The correlation coefficient, r = 0.782, was statistically significant (P < 0.001). Bilabial diameter on MRI was not significantly different from that on ultrasound (P < 0.001). In addition, on MRI we observed changes in morphology of the external genitalia and in signal intensities with increasing gestational age. We have provided a reference range of fetal bilabial diameter on MRI, which, in addition to ultrasound findings, may be helpful in the identification of genital anomalies.
    Ultrasound in Obstetrics and Gynecology 02/2011; 38(6):695-700. · 3.01 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

46,XY small-for-gestational-age males
 
ambiguous genitalia
 
androgen insensitivity syndrome
 
Children's Hospital
 
common diagnoses
 
cytogenetics
 
following specialties
 
Gender Assessment Team
 
genetic counseling
 
genetic testing options
 
intersex disorders
 
major diagnostic categories
 
medical genetics
 
multidisciplinary team
 
multisystem genetic condition
 
psychosocial support
 
Regional Medical Center
 
surgical treatment
 
syndromes
 
team approach