BMJ Case Reports 2018; doi:10.1136/bcr-2018-225447
  • Rare disease

A challenging case of primary amenorrhoea

  1. Channabasappa Shivaprasad1
  1. 1Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
  2. 2General Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
  1. Correspondence to Dr Vijaya Sarathi, drvijayasarathi{at}
  • Accepted 24 June 2018
  • Published 11 July 2018


The differential diagnosis of a girl presenting with primary amenorrhoea includes numerous conditions. Often, patients of 46XY disorder of sex development (DSD) are reared as girl and present with primary amenorrhoea. Their further evaluation to reach the final diagnosis is often a great challenge. In this article, we report a challenging case of 46XY DSD presented with primary amenorrhoea. Patient had spontaneous breast development which initially confused the diagnosis to complete androgen insensitivity syndrome. However, low testosterone suggested against this possibility and further evaluation revealed hormonal findings consistent with 17α hydroxylase/17,20 lyase (CYP17A1) deficiency. Patient had 46XY karyotype and in consistence with hormonal findings patient was found to have a likely pathogenic homozygous c.1345C>T (p.Arg449Cys) variation in exon 8 of CYP17A1.


  • Contributors Patient was evaluated by VS, SA and CS. RR did the bilateral orchidectomy. VS drafted the manuscript; all others critically reviewed and approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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