Chen Guangjie, Wang Xiaohao, Tang Daxing
Department of Urology, the Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2019 Jun 25;48(4):358-366. doi: 10.3785/j.issn.1008-9292.2019.08.02.
Disorders of sex development (DSD) refer to a group of diseases characterized by abnormal congenital development of chromosomes, gonad or genitals with different pathophysiological changes and clinical manifestations. DSD is more common in neonates and adolescents, and neonates often show genital abnormalities while adolescents show abnormal sexual development during puberty. It is the international consensus that the scope of DSD should include basic clinical evaluation (internal and external genitalia and endocrine hormones), diagnostic confirmation (chromosome, genetic diagnosis), psychological assessment for children and family, treatment (sex assignment, hormone replacement and surgical intervention), potential fertility protection and long-term follow-up, which require the expertise of pediatric endocrinology, pediatric urology, clinical psychology, genetic disciplines, medical images and other related disciplines; that is, individualized management of children with DSD requires an experienced multidisciplinary team (MDT). This article reviews the recent progress on the evaluation, diagnosis and management of disorders of sex development.
性发育障碍(DSD)是指一组以染色体、性腺或生殖器先天性发育异常为特征的疾病,具有不同的病理生理变化和临床表现。DSD在新生儿和青少年中更为常见,新生儿常表现为生殖器异常,而青少年则在青春期出现性发育异常。国际共识认为,DSD的范畴应包括基本临床评估(内外生殖器及内分泌激素)、诊断确认(染色体、基因诊断)、儿童及家庭的心理评估、治疗(性别指定、激素替代及手术干预)、潜在生育力保护及长期随访,这需要儿科内分泌学、小儿泌尿外科学、临床心理学、遗传学学科、医学影像学等相关学科的专业知识;也就是说,对DSD患儿进行个体化管理需要一个经验丰富的多学科团队(MDT)。本文综述了性发育障碍评估、诊断及管理方面的最新进展。