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46,xx sex reversal 5(SRXX5)

MedGen UID:
1713956
Concept ID:
C5394441
Disease or Syndrome
Synonyms: 46,XX SEX REVERSAL 5; SRXX5
 
Gene (location): NR2F2 (15q26.2)
 
Monarch Initiative: MONDO:0030049
OMIM®: 618901

Definition

SRXX5 is characterized by genital virilization in 46,XX individuals, associated with congenital heart disease and variable somatic anomalies including blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) and congenital diaphragmatic hernia (Bashamboo et al., 2018). [from OMIM]

Clinical features

From HPO
Ambiguous genitalia
MedGen UID:
78596
Concept ID:
C0266362
Congenital Abnormality
A genital phenotype that is not clearly assignable to a single gender. Ambiguous genitalia can be evaluated using the Prader scale
Urogenital sinus anomaly
MedGen UID:
867587
Concept ID:
C4021972
Anatomical Abnormality
A rare birth defect in women where the urethra and vagina both open into a common channel.
Ventricular septal defect
MedGen UID:
42366
Concept ID:
C0018818
Congenital Abnormality
A hole between the two bottom chambers (ventricles) of the heart. The defect is centered around the most superior aspect of the ventricular septum.
Hypoplastic left heart syndrome
MedGen UID:
57746
Concept ID:
C0152101
Disease or Syndrome
Critical congenital heart disease (CCHD) is a term that refers to a group of serious heart defects that are present from birth. These abnormalities result from problems with the formation of one or more parts of the heart during the early stages of embryonic development. CCHD prevents the heart from pumping blood effectively or reduces the amount of oxygen in the blood. As a result, organs and tissues throughout the body do not receive enough oxygen, which can lead to organ damage and life-threatening complications. Individuals with CCHD usually require surgery soon after birth.\n\nAlthough babies with CCHD may appear healthy for the first few hours or days of life, signs and symptoms soon become apparent. These can include an abnormal heart sound during a heartbeat (heart murmur), rapid breathing (tachypnea), low blood pressure (hypotension), low levels of oxygen in the blood (hypoxemia), and a blue or purple tint to the skin caused by a shortage of oxygen (cyanosis). If untreated, CCHD can lead to shock, coma, and death. However, most people with CCHD now survive past infancy due to improvements in early detection, diagnosis, and treatment.\n\nSome people with treated CCHD have few related health problems later in life. However, long-term effects of CCHD can include delayed development and reduced stamina during exercise. Adults with these heart defects have an increased risk of abnormal heart rhythms, heart failure, sudden cardiac arrest, stroke, and premature death.\n\nEach of the heart defects associated with CCHD affects the flow of blood into, out of, or through the heart. Some of the heart defects involve structures within the heart itself, such as the two lower chambers of the heart (the ventricles) or the valves that control blood flow through the heart. Others affect the structure of the large blood vessels leading into and out of the heart (including the aorta and pulmonary artery). Still others involve a combination of these structural abnormalities.\n\nPeople with CCHD have one or more specific heart defects. The heart defects classified as CCHD include coarctation of the aorta, double-outlet right ventricle, D-transposition of the great arteries, Ebstein anomaly, hypoplastic left heart syndrome, interrupted aortic arch, pulmonary atresia with intact septum, single ventricle, total anomalous pulmonary venous connection, tetralogy of Fallot, tricuspid atresia, and truncus arteriosus.
Atrial septal defect, ostium secundum type
MedGen UID:
91034
Concept ID:
C0344724
Congenital Abnormality
A kind of atrial septum defect arising from an enlarged foramen ovale, inadequate growth of the septum secundum, or excessive absorption of the septum primum.
Aplasia of the left hemidiaphragm
MedGen UID:
1680550
Concept ID:
C5194758
Finding
Congenital absence of the left half of the diaphragm.
Increased serum testosterone level
MedGen UID:
892551
Concept ID:
C4072885
Finding
An elevated circulating testosterone level in the blood.

Professional guidelines

PubMed

Fukami M, Nishimura G, Homma K, Nagai T, Hanaki K, Uematsu A, Ishii T, Numakura C, Sawada H, Nakacho M, Kowase T, Motomura K, Haruna H, Nakamura M, Ohishi A, Adachi M, Tajima T, Hasegawa Y, Hasegawa T, Horikawa R, Fujieda K, Ogata T
J Clin Endocrinol Metab 2009 May;94(5):1723-31. Epub 2009 Mar 3 doi: 10.1210/jc.2008-2816. PMID: 19258400
Pinhas-Hamiel O, Zalel Y, Smith E, Mazkereth R, Aviram A, Lipitz S, Achiron R
J Clin Endocrinol Metab 2002 Oct;87(10):4547-53. doi: 10.1210/jc.2001-011034. PMID: 12364433

Recent clinical studies

Etiology

Vilanova-Sanchez A, McCracken K, Halleran DR, Wood RJ, Reck-Burneo CA, Levitt MA, Hewitt G
J Pediatr Adolesc Gynecol 2019 Feb;32(1):7-14. Epub 2018 Oct 24 doi: 10.1016/j.jpag.2018.10.002. PMID: 30367985
Berglund A, Johannsen TH, Stochholm K, Aksglaede L, Fedder J, Viuff MH, Main KM, Gravholt CH
Hum Reprod 2017 Aug 1;32(8):1751-1760. doi: 10.1093/humrep/dex210. PMID: 28854582
Chan AO, But WM, Lee CY, Lam YY, Ng KL, Loung PY, Lam A, Cheng CW, Shek CC, Wong WS, Wong KF, Wong MY, Tse WY
Hong Kong Med J 2015 Dec;21(6):499-510. Epub 2015 Oct 16 doi: 10.12809/hkmj144402. PMID: 26492835
Vasu VR, Saranya B, Jayashankar M, Munirajan AK, Santhiya ST
Genet Test Mol Biomarkers 2012 Jul;16(7):749-55. doi: 10.1089/gtmb.2011.0292. PMID: 22799610
Lim HN, Berkovitz GD, Hughes IA, Hawkins JR
Hum Genet 2000 Dec;107(6):650-2. Epub 2000 Nov 14 doi: 10.1007/s004390000428. PMID: 11153920

Diagnosis

Berglund A, Johannsen TH, Stochholm K, Aksglaede L, Fedder J, Viuff MH, Main KM, Gravholt CH
Hum Reprod 2017 Aug 1;32(8):1751-1760. doi: 10.1093/humrep/dex210. PMID: 28854582
Haines B, Hughes J, Corbett M, Shaw M, Innes J, Patel L, Gecz J, Clayton-Smith J, Thomas P
J Clin Endocrinol Metab 2015 May;100(5):E815-20. Epub 2015 Mar 17 doi: 10.1210/jc.2014-4383. PMID: 25781358
Smith CA, Shoemaker CM, Roeszler KN, Queen J, Crews D, Sinclair AH
BMC Dev Biol 2008 Jul 24;8:72. doi: 10.1186/1471-213X-8-72. PMID: 18651984Free PMC Article
Pinhas-Hamiel O, Zalel Y, Smith E, Mazkereth R, Aviram A, Lipitz S, Achiron R
J Clin Endocrinol Metab 2002 Oct;87(10):4547-53. doi: 10.1210/jc.2001-011034. PMID: 12364433
Chen H
Keio J Med 1994 Jun;43(2):98-107. doi: 10.2302/kjm.43.98. PMID: 8089961

Therapy

Berglund A, Johannsen TH, Stochholm K, Aksglaede L, Fedder J, Viuff MH, Main KM, Gravholt CH
Hum Reprod 2017 Aug 1;32(8):1751-1760. doi: 10.1093/humrep/dex210. PMID: 28854582
Brännström M, Johannesson L, Bokström H, Kvarnström N, Mölne J, Dahm-Kähler P, Enskog A, Milenkovic M, Ekberg J, Diaz-Garcia C, Gäbel M, Hanafy A, Hagberg H, Olausson M, Nilsson L
Lancet 2015 Feb 14;385(9968):607-616. Epub 2014 Oct 6 doi: 10.1016/S0140-6736(14)61728-1. PMID: 25301505
Vasu VR, Saranya B, Jayashankar M, Munirajan AK, Santhiya ST
Genet Test Mol Biomarkers 2012 Jul;16(7):749-55. doi: 10.1089/gtmb.2011.0292. PMID: 22799610

Prognosis

Berglund A, Johannsen TH, Stochholm K, Aksglaede L, Fedder J, Viuff MH, Main KM, Gravholt CH
Hum Reprod 2017 Aug 1;32(8):1751-1760. doi: 10.1093/humrep/dex210. PMID: 28854582

Clinical prediction guides

Wei J, Liu C, Zhang M, Liu S, Fu J, Lin P
BMC Med Genomics 2022 Sep 5;15(1):188. doi: 10.1186/s12920-022-01347-0. PMID: 36064700Free PMC Article
Brännström M, Johannesson L, Bokström H, Kvarnström N, Mölne J, Dahm-Kähler P, Enskog A, Milenkovic M, Ekberg J, Diaz-Garcia C, Gäbel M, Hanafy A, Hagberg H, Olausson M, Nilsson L
Lancet 2015 Feb 14;385(9968):607-616. Epub 2014 Oct 6 doi: 10.1016/S0140-6736(14)61728-1. PMID: 25301505
Pinhas-Hamiel O, Zalel Y, Smith E, Mazkereth R, Aviram A, Lipitz S, Achiron R
J Clin Endocrinol Metab 2002 Oct;87(10):4547-53. doi: 10.1210/jc.2001-011034. PMID: 12364433
Cameron FJ, Hageman RM, Cooke-Yarborough C, Kwok C, Goodwin LL, Sillence DO, Sinclair AH
Hum Mol Genet 1996 Oct;5(10):1625-30. doi: 10.1093/hmg/5.10.1625. PMID: 8894698

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