Is hypospadias a genetic, endocrine or environmental disease, or still an unexplained malformation?
Article first published online: 11 JUL 2008
© 2008 The Authors. Journal compilation © 2008 European Academy of Andrology
International Journal of Andrology
Volume 32, Issue 3, pages 187–197, June 2009
How to Cite
Kalfa, N., Philibert, P. and Sultan, C. (2009), Is hypospadias a genetic, endocrine or environmental disease, or still an unexplained malformation?. International Journal of Andrology, 32: 187–197. doi: 10.1111/j.1365-2605.2008.00899.x
- Issue published online: 5 MAY 2009
- Article first published online: 11 JUL 2008
- Received 11 March 2008; revised 2 May 2008; accepted 13 May 2008
- sex determination;
- sex differentiation disorders
Hypospadias is one of the most frequent genital malformations in the male newborn and results from an abnormal penile and urethral development. This process requires a correct genetic programme, time- and space-adapted cellular differentiation, complex tissue interactions, and hormonal mediation through enzymatic activities and hormonal transduction signals. Any disturbance in these regulations may induce a defect in the virilization of the external genitalia and hypospadias. This malformation thus appears to be at the crossroads of various mechanisms implicating genetic and environmental factors. The genes of penile development (HOX, FGF, Shh) and testicular determination (WT1, SRY) and those regulating the synthesis [luteinizing hormone (LH) receptor] and action of androgen (5α reductase, androgen receptor) can cause hypospadias if altered. Several chromosomal abnormalities and malformative syndromes include hypospadias, from anterior to penoscrotal forms. More recently, CXorf6 and ATF3 have been reported to be involved. Besides these genomic and hormonal factors, multiple substances found in the environment can also potentially interfere with male genital development because of their similarity to hormones. The proportion of hypospadias cases for which an aetiology is detected varies with the authors but it nevertheless remains low, especially for less severe cases. An interaction between genetic background and environment is likely.