Chrysanthi Kouri, Rawda Naamneh-Elzenaty, Idoia Martinez de Lapiscina, Christa E Flück
{"title":"Broader impact and outcome of human NR5A1/SF1 variants.","authors":"Chrysanthi Kouri, Rawda Naamneh-Elzenaty, Idoia Martinez de Lapiscina, Christa E Flück","doi":"10.1016/j.beem.2025.102023","DOIUrl":"https://doi.org/10.1016/j.beem.2025.102023","url":null,"abstract":"<p><p>Nuclear Receptor Subfamily 5 Group A Member 1, also known as Steroidogenic Factor 1 (NR5A1/SF-1), plays a crucial role in human sex development and steroidogenesis. Pathogenic variants in the NR5A1 gene are well-established causes of 46,XY and 46,XX differences in sex development (DSD) and primary ovarian insufficiency. While numerous studies have demonstrated that these variants impair puberty and fertility, the full spectrum of pubertal and reproductive effects in affected individuals remains difficult to define. Emerging evidence suggests broader, long-term implications beyond gonadal function, including effects on spleen function and metabolic health, not only in individuals with DSD, but also in asymptomatic carriers of NR5A1/SF-1 variants within the general population. However, these findings require validation through larger, longitudinal studies. This review provides a comprehensive overview of current knowledge and existing gaps, emphasizing the broader impact and long-term effects of NR5A1/SF-1 variants.</p>","PeriodicalId":93894,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":" ","pages":"102023"},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna Nordenström, Alessandra Mangone, Giovanna Mantovani
{"title":"Hormone replacement in disorders of sex development, and long-term effects.","authors":"Anna Nordenström, Alessandra Mangone, Giovanna Mantovani","doi":"10.1016/j.beem.2025.102022","DOIUrl":"https://doi.org/10.1016/j.beem.2025.102022","url":null,"abstract":"<p><p>Disorders of sex development, DSD, are in the majority of cases caused by alterations in the gonadal or adrenal function that affect steroid hormone synthesis or action. Gonadal deficiencies result in a need for testosterone or estradiol replacement to achieve pubertal development as well as for continuous life-long replacement with sex hormones. In cases with adrenal enzyme deficiencies, glucocorticoid and sometimes mineralocorticoid replacement may be required to normalize the hormonal situation. Long-term outcomes related to growth, bone mineral density, cardiovascular and metabolic health, as well as psychosocial wellbeing, are increasingly being reported, both in relation to different treatment strategies and as a consequence of insufficient or absent treatment. Transition from pediatric to adult care is a vulnerable period which needs to be organized and individually tailored to ensure lifelong treatment and optimized general health. Individuals with a DSD should be seen by multidisciplinary teams at all ages, for diagnostic evaluation, for treatment and for long-term clinical follow-up.</p>","PeriodicalId":93894,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":" ","pages":"102022"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Gonadectomy in individuals with a difference of sex development - For whom, when, why, and why not?","authors":"Sabine E Hannema, Michele A O'Connell","doi":"10.1016/j.beem.2025.102019","DOIUrl":"https://doi.org/10.1016/j.beem.2025.102019","url":null,"abstract":"<p><p>Several forms of differences of sex development (DSD) are associated with an increased risk of gonadal germ cell cancer, which can be prevented by a gonadectomy. However, when considering prophylactic gonadectomy potential benefits need to be carefully weighed against potential harms, taking into account factors such as endocrine function of the gonad, potential fertility and the risk of germ cell cancer. While evidence is available for particular diagnoses, to assess gonadal function and risk at an individual level remains challenging. A comprehensive approach to assessment is described. Alternatives to gonadectomy include surveillance for cancer development but current methods have low sensitivity and specificity. Undesired sex steroid production can be suppressed with GnRH analogue treatment. Unless it poses an unacceptable medical risk, it is generally preferable to delay a decision regarding gonadectomy until the individual can be involved in a shared decision making process.</p>","PeriodicalId":93894,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":" ","pages":"102019"},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The management of hypothalamic obesity in craniopharyngioma.","authors":"Paul Dimitri","doi":"10.1016/j.beem.2025.102018","DOIUrl":"https://doi.org/10.1016/j.beem.2025.102018","url":null,"abstract":"<p><p>Hypothalamic obesity (HO) is a severe, treatment-refractory metabolic disorder resulting from hypothalamic injury secondary to craniopharyngioma directly or from its surgical resection. Characterised by dysregulated energy balance from disruption of complex hypothalamic neuroregulatory circuits, hyperphagia, and reduced sympathetic tone, HO arises due to impaired leptin-melanocortin signalling and autonomic dysfunction. Conventional lifestyle modifications remain largely ineffective, necessitating pharmacotherapeutic approaches targeting neuroendocrine and metabolic pathways. Amelioration of sleep disturbances and pituitary dysfunction serve as an important foundation for management of HO. The use of dextroamphetamine in some HO patients has proved effective. Emerging therapies include melanocortin-4 receptor (MC4R) agonists such as setmelanotide, which restore anorexigenic signalling, glucagon-like peptide-1 (GLP-1) receptor agonists that enhance satiety and energy expenditure, and combination strategies integrating adrenergic modulation (Tesomet). Despite promising preliminary data, long-term efficacy and safety profiles require further validation. Optimizing precision medicine approaches incorporating polypharmacotherapy and neuroendocrine modulation may redefine therapeutic paradigms for HO management.</p>","PeriodicalId":93894,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":" ","pages":"102018"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Care quality improvement in differences of sex development.","authors":"Ulla Döhnert, Justin H Davies","doi":"10.1016/j.beem.2025.102016","DOIUrl":"https://doi.org/10.1016/j.beem.2025.102016","url":null,"abstract":"<p><p>Collaborative efforts across Europe and the world aim to improve the care quality provided to individuals with differences of sex development (DSD). Quality management in healthcare ensures that patients receive evidence-based and consistently high-quality care. Healthcare quality is categorised into the three interrelated components: structure, process and outcome. Quality indicators serve as proxies to demonstrate whether good quality is achieved and can be used for benchmarking purposes. This article highlights how the categories of structure, process, and outcome quality can be applied to the care for individuals with DSD. We review the implementation of benchmarking to continually assess and improve the care for people with DSD at a national level and how DSD studies may inform benchmarking at an international level.</p>","PeriodicalId":93894,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":" ","pages":"102016"},"PeriodicalIF":0.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Morgane Carre Lecoindre, Courtney Finlayson, Philippe Touraine
{"title":"Fertility in differences of sex development patients.","authors":"Morgane Carre Lecoindre, Courtney Finlayson, Philippe Touraine","doi":"10.1016/j.beem.2025.102017","DOIUrl":"https://doi.org/10.1016/j.beem.2025.102017","url":null,"abstract":"<p><p>Management of differences of sex development (DSD) continues to evolve, with increased attention to fertility. Knowledge gaps remain among providers and patients about fertility potential and options for fertility preservation. It is complicated, requiring individualized assessment. Fertility potential varies by diagnosis, gonadal status and age. Many DSD conditions confer increased risk of gonadal germ cell tumor, prompting consideration of prophylactic gonadectomy and loss of potential germ cells or gametes. These potential gametes also may not match the sex designation or gender identity. Some causes of DSD are heritable, thus genetic counseling is important to address inheritance risks. Fertility considerations are further complicated by the need for some management decisions to occur during the pediatric period, an individual may not be able to assent or consent, and decisions may be made by parents. Advances in ART and fertility preservation techniques have improved outcomes, and investigational techniques may offer more future options.</p>","PeriodicalId":93894,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":" ","pages":"102017"},"PeriodicalIF":0.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Defining sex in the sporting world.","authors":"David J Handelsman, Stéphane Bermon","doi":"10.1016/j.beem.2025.102005","DOIUrl":"https://doi.org/10.1016/j.beem.2025.102005","url":null,"abstract":"<p><p>At an elite international level, professional sports have a well-established fairness-based binary sex classification which is challenged by male-bodied athletes with female gender identity, notably male-to-female transgender and XY Disorders of Sex Development (DSD) individuals seeking to compete in female events. For sports where success depends on power and/or endurance, physical advantages stemming from male puberty, which produces men's circulating testosterone concentrations 20-30 times those of children or women at any age, leading to larger and stronger muscles, bones, cardiorespiratory functions and blood hemoglobin. Yet complete suppression of endogenous testosterone after male puberty leaves a legacy of reduced but not eliminated physical advantages. Hence a protected female category in power sports is essential to allow women a fair and safe chance at the fame and fortune derived from success. For community, recreational and youth sports, or those without male physical advantages invoking safety or fairness issues, inclusivity may prevail.</p>","PeriodicalId":93894,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":" ","pages":"102005"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mariska Peck, Paul Connelly, Angela K Lucas-Herald
{"title":"Cardiometabolic outcomes of early onset hypogonadism in males.","authors":"Mariska Peck, Paul Connelly, Angela K Lucas-Herald","doi":"10.1016/j.beem.2025.102004","DOIUrl":"https://doi.org/10.1016/j.beem.2025.102004","url":null,"abstract":"<p><p>Testosterone is an important vascular hormone, with multiple effects reported on the vasculature. As such, boys and men with early onset hypogonadism may have altered cardiovascular function, with the potential to result in adverse cardiometabolic outcomes in adulthood. Given the fact that cardiovascular changes in the young can affect future cardiovascular health, there is a need to better understand the influence of androgens on the vasculature in those with conditions such as 46, XY Disorders of Sex Development and Klinefelter Syndrome. This review summarises what is known about hypogonadism and the effects of testosterone supplementation in adults with hypogonadism, as well as what is currently understood in those with early onset hypogonadism specifically. A number of research gaps persist in this area and there is a need for international collaborative studies to address these for future generations of affected individuals.</p>","PeriodicalId":93894,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":" ","pages":"102004"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Agnethe Berglund, Simon Chang, Marie Lind-Holst, Kirstine Stochholm, Claus Højbjerg Gravholt
{"title":"The epidemiology of disorders of sex development.","authors":"Agnethe Berglund, Simon Chang, Marie Lind-Holst, Kirstine Stochholm, Claus Højbjerg Gravholt","doi":"10.1016/j.beem.2025.102002","DOIUrl":"https://doi.org/10.1016/j.beem.2025.102002","url":null,"abstract":"<p><p>During recent years the epidemiology of disorders of sex development (DSD) has been more clearly delineated. Here, we provide a detailed and up-to-date synopsis of the epidemiology of DSD, incorporating the latest body of knowledge in the field for sex chromosome DSD (Turner, Klinefelter, 47,XXX, and 47,XXY syndrome, and 45,X/46,XY mosaicism) as well as for 46,XX DSD and 46,XY DSD focusing on females with congenital adrenal hyperplasia (CAH), males with 46,XX DSD, females with Mayer-Rokitansky-Küster-Hauser syndrome and females with 46,XY DSD. Despite not fitting directly within the Chicago Consensus classification for DSD, we also include the few epidemiological studies addressing ambiguous genitalia. We show that epidemiological studies have improved our understanding of DSD and led to sound estimates of prevalence, have detailed morbidity and mortality patterns and have for some conditions also shed light on the impact on socioeconomic achievements.</p>","PeriodicalId":93894,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":" ","pages":"102002"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Androgen insensitivity and the evolving genetic heterogeneity.","authors":"Nadine Hornig, Rafael Loch Batista","doi":"10.1016/j.beem.2025.102000","DOIUrl":"https://doi.org/10.1016/j.beem.2025.102000","url":null,"abstract":"<p><p>Androgen Insensitivity Syndrome (AIS) is a 46,XY difference of sex development (DSD) classically caused by mutations in the androgen receptor (AR) gene, leading to variable androgen resistance and a broad phenotypic spectrum traditionally classified as complete, partial, or mild. Phenotypic variability can occur even with identical AR mutations, particularly those within the ligand-binding domain of the AR. Emerging evidence implicates non-coding regulatory variants, deep intronic mutations, AR co-regulator dysfunction, and oligogenic inheritance in the aetiology of AIS. The molecular diagnostic workflow should incorporate either targeted AR sequencing or whole-exome sequencing, depending on the clinical context. Biochemical and functional assays remain clinically useful, especially when AR variants are not detected or when variants of unknown significance (VUS) are identified. Advances in patient-derived hiPSC models and testicular organoids provide new insights into AR function and therapeutic strategies. Expanding genomic and epigenetic research will refine diagnostic accuracy, and personalized care, ultimately optimizing patient outcomes in AIS.</p>","PeriodicalId":93894,"journal":{"name":"Best practice & research. Clinical endocrinology & metabolism","volume":" ","pages":"102000"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}