A Management Protocol for Gonad Preservation in Patients with Androgen Insensitivity Syndrome
| Autor: | Kathleen van Leeuwen, Erica M. Weidler, Veronica Gomez-Lobo, Luis F. Goncalves, Arlene B. Baratz, S. Janett Hernandez, Smita Bailey, Maria E. Linnaus |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male endocrine system Gonad Adolescent media_common.quotation_subject Fertility Bioinformatics Malignancy Article Clinical Protocols Testicular Neoplasms medicine Humans In patient Castration Gonads media_common business.industry Sexual Development Obstetrics and Gynecology Fertility Preservation General Medicine Androgen-Insensitivity Syndrome Neoplasms Germ Cell and Embryonal Late adolescence medicine.disease Clinical Practice medicine.anatomical_structure Pediatrics Perinatology and Child Health Androgen insensitivity syndrome Female business Hormone |
| Zdroj: | J Pediatr Adolesc Gynecol |
| ISSN: | 1873-4332 |
| Popis: | Historically, individuals with androgen insensitivity syndrome (AIS) were managed with removal of gonadal tissue at various ages to avert the risk of gonadal malignancy. Recently, clinical practice changed, with gonadectomy being postponed until late adolescence. Adolescents and adults with complete AIS have questioned this approach. Additionally, testicular germ cell tumors are increasingly believed to be quite rare with rates as low as 0% in molecularly confirmed individuals with AIS. Gonadectomy deprives patients of the benefits of their endogenous hormones and potential fertility. Furthermore, human rights organizations advocate for deferring irreversible surgery in conditions known as differences of sex development, which includes AIS, to allow patient autonomy in decision-making. Recent literature supports an approach that uses risk stratification to manage gonads in AIS. Herein we review what is known about malignancy risk in the different subtypes of AIS and propose a management protocol for gonad retention. |
| Databáze: | OpenAIRE |
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