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Gonadectomy fails to affect BMD in complete androgen insensitivity syndrome
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Women with complete androgen insensitivity syndrome have decreased bone mineral density at the lumbar spine and hip, which appears to be unaffected after gonadectomy, according to findings published in Clinical Endocrinology.
Gerard S. Conway, MD, FRCP, of the department of endocrinology at University College Hospital and professor in the Institute for Women’s Health at University College London Hospitals, and colleagues evaluated 113 women with complete androgen insensitivity syndrome to determine the relationship between age of gonadectomy and BMD.
Researchers evaluated DXA before and after gonadectomy and the presurgical hormone profile.
The mean age of the patients at DXA was 33.8 years; mean BMD was reduced at the lumbar spine (T-score, –1.34; P < .001) and hip (T-score, –0.3; P = .001). There was a mean interval of 18 years between gonadectomy and most recent DXA. No association was found between age at gonadectomy and T-score at the lumbar spine or hip.
Researchers observed no differences for BMD at the lumbar spine or hip between participants who had gonadectomy before vs. after age 14 years.
Overall, 32 participants had BMD measured within 2 years of gonadectomy; mean age at the time of BMD measurement was 25.4 years. Mean BMD at the lumbar spine was decreased (T-score, –1.05; P < .001) but normal at the hip. No relationship was found between presurgical BMD and BMI, presence of hernia and levels of testosterone, estradiol, luteinizing hormone or follicle-stimulating hormone.
DXA measurements before and after gonadectomy were available in 12 participants with a median time interval of 4.3 years between measurements. Increases in weight (P = .047) and BMI (P = .028) were found after gonadectomy, whereas there was no significant change in BMD before and after surgery.
“We found reduced BMD at the spine and hip in subjects with [complete androgen insensitivity syndrome],” the researchers wrote. “We found no relationship between age at gonadectomy and BMD, and we also found no drop in BMD in subjects followed up after gonadectomy. A subset with T-score < –2 requires further investigation as it may represent a novel phenotype. We recommend regular BMD monitoring in all subjects and lifelong sex steroid replacement after surgery. Our findings support current practice to defer gonadectomy until after completion of puberty. We could identify no long-term risk of retained gonads in terms of bone density, but note the risk of malignancy in this group that cannot be attenuated by current screening tools.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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