Frontiers in Medicine (Aug 2024)

Case report: Rare heterozygous variant in the NR5A1 gene causing 46,XY complete gonadal dysgenesis with a non-communicating rudimentary uterus

  • Toru Sasaki,
  • Shinji Suzuki,
  • Masanori Ono,
  • Akiko Yamamoto,
  • Masato Bingo,
  • Masato Bingo,
  • Gaku Yamanaka,
  • Masahiko Kuroda,
  • Natsuko Inagaki,
  • Natsuko Inagaki,
  • Hirotaka Nishi

DOI
https://doi.org/10.3389/fmed.2024.1441990
Journal volume & issue
Vol. 11

Abstract

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The nuclear receptor subfamily 5 group A member 1 (NR5A1) gene encodes NR5A1, also known as steroidogenic factor 1, a crucial transcriptional factor regulating adrenal and gonadal development and function. Although pathogenic variants in NR5A1 are known to cause a spectrum of disorders of sex development (DSD), individuals with 46,XY DSD with fully female internal and external genitalia are relatively rare. Herein, we present the case of a patient with 46,XY complete gonadal dysgenesis (CGD) who had a non-communicating rudimentary uterus due to a c.132_134del (p.Asn44del) heterozygous in-frame-deletion in NR5A1 that was diagnosed while treating a pelvic mass in which gynecological malignancy could not be disregarded. Unlike two previous cases with the p.Asn44del variant, this case presented with CGD, a severe DSD phenotype, and we found that the oligogenic inheritance of DSD-causative genes such as SRY, DHX37, SLC26A8, and CFTR may have affected the severity of the clinical phenotype.

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