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Response to Androgen Treatment in a Patient with Partial Androgen Insensitivity and a Mutation in the Deoxyribonucleic Acid-Binding Domain of the Androgen Receptor¹

Institute of Zoophysiology, Department of Endocrinology and Developmental Biology, University of Düsseldorf (W.W., B.P.), Düsseldorf; the Department of Internal Medicine, University of Bonn (G.R., H.-U.S.), Bonn; and the Department of General Zoology, University of Ulm (K.-D.S.), Ulm, Germany

Address all correspondence and requests for reprints to: Hans-Udo Schweikert, M.D., Endocrinology, Department of Internal Medicine, University of Bonn, Wilhelmstrasse 35–37, 53111 Bonn, Germany.

Abstract

Supplemental androgen therapy has enhanced virilization in only a few patients with partial androgen insensitivity (PAIS). We herein report on virilization in a patient with PAIS and a point mutation in the DNA-binding domain of the androgen receptor. At the age of 19 yr, the patient sought medical attention because of undervirilization. Endocrine findings were typical for androgen insensitivity, but 5-reductase activity and androgen binding characteristics in fibroblasts cultured from genital skin were normal. In an attempt to improve virilization, high dose testosterone enanthate treatment (250 mg by im injection once a week) was begun. After 3.5 yr of this treatment, marked promotion of virilization was achieved, i.e. lowering of voice, male pattern secondary hair distribution, marked growth of beard and coarse body hair, increase in phallic size, increase in bone mineral density, and decrease in mammary gland size. In addition, serum lipid levels were not affected. To our knowledge this is the first documentation of successful treatment in a patient with PAIS and a point mutation in the DNA-binding domain of the androgen receptor.

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