Highlights
- •Individuals with androgen insensitivity syndrome are subject to long-term complications.
- •The increased risk of germ cell tumours implies the need for gonadectomy for the majority of patients.
- •Osteoporosis has been observed even before gonadectomy.
- •Surgical procedures may be indicated due to gynaecomastia, hypospadias or blind-ending vagina.
- •Besides infertility, increased risks of cardiovascular disease, obesity, diabetes and psychiatric disorders have been demonstrated.
Abstract
Androgen insensitivity syndrome (AIS) is one of the most common sexual developmental
disorders. According to the grade of the remaining androgen receptor (AR) function,
AIS is classified as complete (CAIS), partial (PAIS) or mild (MAIS). In CAIS, the
prevalence of germ cell tumours is increased compared with the general population.
Although patients with CAIS used to undergo gonadectomy before puberty, nowadays a
gonadectomy is recommended after spontaneous puberty, and up to 15% of patients retain
their gonads. Nevertheless, the risk of germ cell tumour increases gradually after
puberty. Annual follow-up with ultrasound or magnetic resonance imaging (MRI) is recommended.
Unfortunately, these imaging methods are not sensitive enough for the diagnosis of
an in situ germ cell tumour. In PAIS, the risk of germ cell tumour is higher than in CAIS; therefore,
an early gonadectomy or an orchidopexy is indicated. Optimal hormone replacement therapy
(HRT) is necessary for long-term health. The risks of osteopenia and of regimen osteoporosis
are higher, ESPECIALLY in patients with early gonadectomy. Infertility is the rule
in CAIS and PAIS. A few mutations do not affect fertility detrimentally, and these
are responsible for MAIS. In PAIS leading to a predominantly male phenotype or ambiguous
genitalia, multiple surgical procedures for gynaecomastia and/or hypospadias are required.
Some small studies have found a higher risk of obesity, hyperlipidaemia and impaired
insulin sensitivity. Psychological support is essential, as the prevalence of psychiatric
disorders is increased. In conclusion, the diagnosis of AIS has long-term consequences
for which shared decision-making (physicians, patients, parents) is appropriate.
Keywords
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Article info
Publication history
Published online: June 05, 2019
Accepted:
June 4,
2019
Received in revised form:
June 2,
2019
Received:
May 26,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
