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Coexistence of Kallmann syndrome and complete androgen insensitivity in the same patient

¹ Service d’Endocrinologie and ³ Service d’Orthopédie, Hôtel-Dieu de France Hospital, Beirut, Lebanon, ² Laboratoire de Biochimie et Génétique, Moléculaires, Hôpital Cochin, Paris, France, ⁴ Unité de Génétique Médicale, Laboratoire de Biologie Moléculaire et Cytogénétique, Faculté de Médecine, Université Saint-Joseph, Beirut, Lebanon, ⁵ Unité de Génétique des Déficits Sensoriels, INSERM U587, Institut Pasteur, Paris, France

(Correspondence should be addressed to A Mégarbané, Université Saint-Joseph, 42 rue de Grenelle, 75007 Paris, France; Email: megarban{at}dm.net.lb)

Abstract

Kallmann syndrome (KS) is a developmental disease that combines hypogonadotropic hypogonadism and anosmia/hyposmia. Other congenital abnormalities may also coexist. This present report describes two sisters, aged 13 and 12 years, born from Lebanese consanguineous parents. The two sisters have complete androgen insensitivity (normal female appearance and an XY karyotype) due to a novel mutation, a C-to-G transversion in intron 2 of the androgen receptor gene, resulting in an aberrant splicing leading to an insertion of 66 nucleotides in the mRNA. In addition, the older sister has KS, together with synkinesia and multiple skeletal abnormalities, mainly kyphosis, vertebral abnormalities, and short right hand and feet. Her testosterone, FSH and LH levels were very low compared with her younger sister. No mutation in the KAL1 and FGFR1/KAL2 genes were found. This unique report raises the possibility of an autosomal recessive or X-linked form of KS with new phenotypic expression.