Relationship among anogenital distance, adrenal gland volume, and penile length and width at 22–36 weeks of pregnancy
Abstract
Objectives
The subject of current work was to determine the relationship of fetal ultrasonographic biomarkers, including anogenital distance (AGD), adrenal gland volume, and penile length and width in mothers with male fetuses at 22–36 weeks of gestation for the assessment of the effect of fetal adrenal gland producing androgens on the male anogenital structures that are exposed to androgen effects as anogenital region and penis.
Methods
This study is a prospective cross-sectional study conducted in our hospital’s outpatient perinatal care unit. One hundred and seventy pregnant women with a male fetus aged 22–36 weeks of gestation were included in the study. The fetal adrenal gland length, width, and depth for the calculation of adrenal volume, AGD, and penile length and width were measured for each participant. The Pearson coefficients were calculated to assess the correlation among these parameters.
Results
The adrenal gland volume had a meaningful, positive moderate relationship with both the AGD (r=0.60) and penile length and width (r=0.57 and r=0.59, respectively; p<0.001). The AGD had a positive, strong correlation with the penile length and width (r=0.74 and r=0.76, respectively; p<0.001).
Conclusions
The fetal adrenal gland as one of the androgen sources of the fetus is an influencer of the development of the anogenital and penile region. The findings of the current study support that the adrenal gland considerably affects the masculinization of male fetuses, since there were remarkable correlations among the AGD, adrenal gland volume, and penile length and width.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Ethical approval: The Institutional Ethical Review Board approved the study (February 16 2022; Registry no:30-2022).
References
1. Gilboa, Y, Kivilevitch, Z, Oren, M, Cohen, YP, Katorza, E, Achiron, R. Anogenital distance in male and female fetuses at 20 to 35 weeks of gestation: centile charts and reference ranges. Prenat Diagn 2014;34:946–51. https://doi.org/10.1002/pd.4399.Suche in Google Scholar PubMed
2. Thankamony, A, Pasterski, V, Ong, KK, Acerini, CL, Hughes, IA. Anogenital distance as a marker of androgen exposure in humans. Andrology 2016;4:616–25. https://doi.org/10.1111/andr.12156.Suche in Google Scholar PubMed PubMed Central
3. Schwartz, C, Christiansen, S, Vinggaard, A, Axelstad, M, Hass, U, Svingen, T. Anogenital distance as a toxicological or clinical marker for fetal androgen action and risk for reproductive disorders. Arch Toxicol 2019;93:253–72. https://doi.org/10.1007/s00204-018-2350-5.Suche in Google Scholar PubMed
4. Nanba, K, Blinder, AR, Rainey, WE. Primary cultures and cell lines for In Vitro modeling of the human adrenal cortex. Tohoku J Exp Med 2021;253:217–32. https://doi.org/10.1620/tjem.253.217.Suche in Google Scholar PubMed
5. Iijima, S. Sonographic evaluation of adrenal size in neonates (23 to 41 weeks of gestation). BMC Pediatr 2018;18:60. https://doi.org/10.1186/s12887-018-1056-4.Suche in Google Scholar PubMed PubMed Central
6. Smitthimedhin, A, Rubio, EI, Blask, AR, Loomis, JM, Bulas, DI. Normal size of the fetal adrenal gland on prenatal magnetic resonance imaging. Pediatr Radiol 2020;50:840–7. https://doi.org/10.1007/s00247-020-04629-w.Suche in Google Scholar PubMed
7. van Vuuren, SH, Damen-Elias, HAM, Stigter, RH, van der Doef, R, Goldschmeding, R, de Jong, TPVM, et al.. Size and volume charts of fetal kidney, renal pelvis and adrenal gland. Ultrasound Obstet Gynecol 2012;40:659–64. https://doi.org/10.1002/uog.11169.Suche in Google Scholar PubMed
8. Danon, D, Ben-Shitrit, G, Bardin, R, Machiach, R, Vardimon, D, Meizner, I. Reference values for fetal penile length and width from 22 to 36 gestational weeks. Prenat Diagn 2012;32:829–32. https://doi.org/10.1002/pd.3913.Suche in Google Scholar PubMed
9. Akpinar, F, Yilmaz, S, Akdag Cirik, D, Kayikcioglu, F, Dilbaz, B, Yucel, H, et al.. Sonographic assessment of the fetal penile development. Fetal Pediatr Pathol 2016;35:88–92. https://doi.org/10.3109/15513815.2015.1135494.Suche in Google Scholar PubMed
10. Perlitz, Y, Keselman, L, Haddad, S, Mukary, M, Izhaki, I, Ben-Ami, M. Prenatal sonographic evaluation of the penile length. Prenat Diagn 2011;31:1283–5. https://doi.org/10.1002/pd.2885.Suche in Google Scholar PubMed
11. Zalel, Y, Pinhas-Hamiel, O, Lipitz, S, Mashiach, S, Achiron, R. The development of the fetal penis--an in utero sonographic evaluation. Ultrasound Obstet Gynecol 2001;17:129–31. https://doi.org/10.1046/j.1469-0705.2001.00216.x.Suche in Google Scholar PubMed
12. Vuillard, E, Chitrit, Y, Dreux, S, Elghoneimi, A, Oury, JF, Muller, F. Sonographic measurement of corpus spongiosum in male fetuses. Prenat Diagn 2011;31:1160–3. https://doi.org/10.1002/pd.2854.Suche in Google Scholar PubMed
13. Aydin, E, Holt, R, Chaplin, D, Hawkes, R, Allison, C, Hackett, G, et al.. Fetal anogenital distance using ultrasound. Prenat Diagn 2019;39:527–35. https://doi.org/10.1002/pd.5459.Suche in Google Scholar PubMed PubMed Central
14. Ozgüner, G, Sulak, O, Koyuncu, E. A morphometric study of suprarenal gland development in the fetal period. Surg Radiol Anat 2012;34:581–7. https://doi.org/10.1007/s00276-012-0959-2.Suche in Google Scholar PubMed
15. Sennaiyan, UN, Melov, SJ, Arcus, C, Kirby, A, Alahakoon, TI. Fetal adrenal gland: total gland volume and fetal zone to total gland ratio as markers of small for gestational age. J Clin Ultrasound 2020;48:377–87. https://doi.org/10.1002/jcu.22852.Suche in Google Scholar PubMed
16. Welsh, M, Suzuki, H, Yamada, G. The masculinization programming window. Endocr Dev 2014;27:17–27. DOI: https://doi.org/10.1159/000363609.Suche in Google Scholar PubMed
17. Pignatti, E, Flück, CE. Adrenal cortex development and related disorders leading to adrenal insufficiency. Mol Cell Endocrinol 2021;527:111206. https://doi.org/10.1016/j.mce.2021.111206.Suche in Google Scholar PubMed
18. Ishimoto, H, Jaffe, RB. Development and function of the human fetal adrenal cortex: a key component in the feto-placental unit. Endocr Rev 2011;32:317–55. https://doi.org/10.1210/er.2010-0001.Suche in Google Scholar PubMed PubMed Central
19. Reisch, N, Taylor, AE, Nogueira, EF, Asby, DJ, Dhir, V, Berry, A, et al.. Alternative pathway androgen biosynthesis and human fetal female virilization. Proc Natl Acad Sci U S A 2019;116:22294–9. https://doi.org/10.1073/pnas.1906623116.Suche in Google Scholar PubMed PubMed Central
20. Hanley, NA, Arlt, W. The human fetal adrenal cortex and the window of sexual differentiation. Trends Endocrinol Metabol 2006;17:391–7. https://doi.org/10.1016/j.tem.2006.10.001.Suche in Google Scholar PubMed
21. Goto, M, Piper Hanley, K, Marcos, J, Wood, PJ, Wright, S, Postle, AD, et al.. In humans, early cortisol biosynthesis provides a mechanism to safeguard female sexual development. J Clin Invest 2006;116:953–60. https://doi.org/10.1172/JCI25091.Suche in Google Scholar PubMed PubMed Central
22. Vieiralves, RR, Ribeiro, GS, Alves, EF, Sampaio, FJ, Favorito, LA. Are anogenital distance and external female genitalia development changed in neural tube defects? Study in human fetuses. J Pediatr Urol 2020;16:654.e1–e8. https://doi.org/10.1016/j.jpurol.2020.07.015.Suche in Google Scholar PubMed
23. Park, JY, Lim, G, Oh, KW, Ryu, DS, Park, S, Jeon, JC, et al.. Penile length, digit length, and anogenital distance according to birth weight in newborn male infants. Kju 2015;56:248–53. https://doi.org/10.4111/kju.2015.56.3.248.Suche in Google Scholar PubMed PubMed Central
24. Pan, Z, Zhu, F, Zhou, K. A systematic review of anogenital distance and gynecological disorders: endometriosis and polycystic ovary syndrome. Front Endocrinol 2021;12:696879. https://doi.org/10.3389/fendo.2021.696879.Suche in Google Scholar PubMed PubMed Central
25. Perlman, S, Toledano, Y, Kivilevitch, Z, Halevy, N, Rubin, E, Gilboa, Y. Foetal sonographic anogenital distance Is longer in polycystic ovary syndrome mothers. J Clin Med 2020;9:2863. https://doi.org/10.3390/jcm9092863.Suche in Google Scholar PubMed PubMed Central
26. Alfuraih, AM, Alotaiby, SA, Alsaadi, MJ, Bukhari, HA, Aldhebaib, AM, Mohtasib, RS. Predictive value and reference ranges of anogenital distance for determining fetal gender in the first trimester: a retrospective cohort study. Saudi Med J 2021;42:1057–64. https://doi.org/10.15537/smj.2021.42.10.20210468.Suche in Google Scholar PubMed PubMed Central
27. Johnson, P, Maxwell, D. Fetal penile length. Ultrasound Obstet Gynecol 2000;15:308–10. https://doi.org/10.1046/j.1469-0705.2000.00090.x.Suche in Google Scholar PubMed
© 2022 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Editorial
- A Celebration of Professor Joachim Dudenhausen
- Reviews
- Gestational complications associated with SARS-CoV-2 infection in pregnant women during 2020–2021: systematic review of longitudinal studies
- Eclampsia a preventable tragedy: an African overview
- Original Articles – Obstetrics
- How do bicornuate uteri alter pregnancy, intra-partum and neonatal risks? A population based study of more than three million deliveries and more than 6000 bicornuate uteri
- Maternal urogenital infection and fetal heart functional assessment – what is the missing link?
- Knowledge and attitudes of pregnant women on maternal immunization against COVID-19 in Croatia
- Retrospective review of GCT cutoff value based on pre-pregnancy BMI class in patients with GDM
- Cervical strain elastography: pattern analysis and cervical sliding sign in preterm and control pregnancies
- Maternal race/ethnicity impacts the success rates of external cephalic version (ECV) in the United States
- Fetal adrenal gland size and umbilical artery Doppler in growth-restricted fetuses
- Counseling pregnant women on calcium: effects on calcium intake
- Relationship among anogenital distance, adrenal gland volume, and penile length and width at 22–36 weeks of pregnancy
- Intra-amniotic inflammation in the mid-trimester of pregnancy is a risk factor for neuropsychological disorders in childhood
- Genetic amniocentesis using atraumatic 29 gauge needle in patients having a chorioamniotic separation
- YouTube as a source of patient information on external cephalic version
- Midwives’ personal and professional attitudes towards women’s delivery choices, interventions and neonatal care
- Maternal serum midkine level in fetal growth restriction: a case-control study
- Original Articles – Neonates
- Interventions for reducing late-onset sepsis in neonates: an umbrella review
- Maternal knowledge of recommendations for safe infant sleep and intentions for implementation – a cross sectional analysis of data from the KUNO-Kids birth cohort study
- Short Communication
- Lysophosphatidylcholine acyltransferase 1 protein is present in maternal blood in the third trimester and is upregulated by antenatal corticosteroids
- Letters to the Editor
- Peripartum hysterectomy at a tertiary university perinatal center – retrospective analysis of the 25-year period
- Neonate, infected mother and monkeypox: the present concern
Artikel in diesem Heft
- Frontmatter
- Editorial
- A Celebration of Professor Joachim Dudenhausen
- Reviews
- Gestational complications associated with SARS-CoV-2 infection in pregnant women during 2020–2021: systematic review of longitudinal studies
- Eclampsia a preventable tragedy: an African overview
- Original Articles – Obstetrics
- How do bicornuate uteri alter pregnancy, intra-partum and neonatal risks? A population based study of more than three million deliveries and more than 6000 bicornuate uteri
- Maternal urogenital infection and fetal heart functional assessment – what is the missing link?
- Knowledge and attitudes of pregnant women on maternal immunization against COVID-19 in Croatia
- Retrospective review of GCT cutoff value based on pre-pregnancy BMI class in patients with GDM
- Cervical strain elastography: pattern analysis and cervical sliding sign in preterm and control pregnancies
- Maternal race/ethnicity impacts the success rates of external cephalic version (ECV) in the United States
- Fetal adrenal gland size and umbilical artery Doppler in growth-restricted fetuses
- Counseling pregnant women on calcium: effects on calcium intake
- Relationship among anogenital distance, adrenal gland volume, and penile length and width at 22–36 weeks of pregnancy
- Intra-amniotic inflammation in the mid-trimester of pregnancy is a risk factor for neuropsychological disorders in childhood
- Genetic amniocentesis using atraumatic 29 gauge needle in patients having a chorioamniotic separation
- YouTube as a source of patient information on external cephalic version
- Midwives’ personal and professional attitudes towards women’s delivery choices, interventions and neonatal care
- Maternal serum midkine level in fetal growth restriction: a case-control study
- Original Articles – Neonates
- Interventions for reducing late-onset sepsis in neonates: an umbrella review
- Maternal knowledge of recommendations for safe infant sleep and intentions for implementation – a cross sectional analysis of data from the KUNO-Kids birth cohort study
- Short Communication
- Lysophosphatidylcholine acyltransferase 1 protein is present in maternal blood in the third trimester and is upregulated by antenatal corticosteroids
- Letters to the Editor
- Peripartum hysterectomy at a tertiary university perinatal center – retrospective analysis of the 25-year period
- Neonate, infected mother and monkeypox: the present concern