weekly_question 23/5/2021

[Admin]

A two-year old girl undergoes a laparoscopic right inguinal hernia repair and is found to have what appear to be testes bilaterally at the internal rings. and no female internal organs. What is the best management strategy for this finding?

A laparoscopic gonadectomy at the time of the hernia repair

B laparoscopic bilateral gonadal biopsy

C genetic and endocrine evaluation followed by early laparoscopic gonadectomy

D genetic and endocrine evaluation without further intervention at the time of hernia repair

[Admin]

D. This patient is a male with both testicles and DSD.
I think no more to be done at this stage followed by chromosomal assignment.

correct

A postoperative evaluation will likely show that this patient has complete androgen insensitivity sydrome.

Although the historical recommendation had been for early gonadectomy in these children, the lower true risk of early maligancy combined with the consequences of gonadectomy make multidisciplinary and shared decision-making more appropriate.

In many cases, gonad preservation with surveillance is the best option.

[magdiloulah]

D. This patient is a male with both testicles and DSD.
I think no more to be done at this stage followed by chromosomal assignment.

[Admin]

D. This patient is a male with both testicles and DSD.
I think no more to be done at this stage followed by chromosomal assignment.

correct

A postoperative evaluation will likely show that this patient has complete androgen insensitivity sydrome.

Although the historical recommendation had been for early gonadectomy in these children, the lower true risk of early maligancy combined with the consequences of gonadectomy make multidisciplinary and shared decision-making more appropriate.

In many cases, gonad preservation with surveillance is the best option.

[Dr.bara]

D is correct

[Admin]

thanks for reply, see answer justification in the post above yours