Al-Jurayyan (2011) conducted a retrospective study in the pediatric endocrine clinic at a university hospital Saudi Arabia during the period 1989-2008. Medical records of 81 children with ambiguous genitalia were reviewed. Fifty three (65%) of the patients were genetically females (46XX). Male genetic sex (46XY) was present in only 28 (35%) patients with a diversity of causes; multiple congenital anomalies in nine (32%), local anorectal anomalies in two (7%), congenital adrenal hyperplasia (3-beta-hydroxysteroid dehydrogenase deficiency) in two (7%), 5-alpha-reductase deficiency in four (14%), partial androgen insensitivity in three (11%), complete androgen insensitivity in four (14%), and hypogonadotrophin deficiency in four (14%). Twenty-five (47%) of females were wrongly assigned as males, where only two (7%) males were wrongly assigned as females.
To determine whether some patients with idiopathic hypospadias (146450) have a mutation in the HSD3B2 gene, Codner et al. (2004) conducted a prospective endocrine and molecular study in 90 patients with hypospadias and 101 healthy fertile male controls. They did not observe a clear steroidogenic pattern suggestive of 3-beta-HSD deficiency in any patient. Two patients had heterozygous missense mutations in the HSD3B2 gene; in another 3 patients, the authors observed heterozygous nucleotide variants in exon 4 that did not produce a change in amino acids. The authors concluded that subtle molecular abnormalities in the HSD3B2 gene may be observed in some patients with apparent idiopathic hypospadias but that this finding is uncommon.
The fetal adrenal cortex lacks expression of the enzyme early on, thus mineralocorticoids (. aldosterone ) and glucocorticoids (. cortisol ) cannot be synthesized. This is significant because cortisol induces type II pneumocytes of the lungs to synthesize and secrete pulmonary surfactant ; without pulmonary surfactant to reduce the alveolar surface tension , premature neonates may die of neonatal respiratory distress syndrome . If delivery is unavoidable (. because of placental abruption , or pre-eclampsia / HELLP syndrome ), then glucocorticoids (. cortisol) can be administered.