<prompt> A baby girl presents with bilateral inguinal masses, thought to be hernias but are found to be testes in the inguinal canals.Which karyoty pe would you expect to find in the child - AIIMS Nov 0446. XX46.XY47,XXY47,XYY  <response>: Ans. is b i.e., 46, XY o Presence of abdominal or inguinal testis suggests testicular feminisation syndrome.o The characteristic features of these disorders are that they are genotypically male AT while phenotypically they are female.o These cases usually present as female with abdominal testis.Prepubertal children with this disorder are often detected when inguinal masses prove to be a testis or when a testis is unexpectedly found during herniorrhapy in phenotypically female.o It is called testicular feminisation syndrome but the name is both stigmatising and inaccurate the testes do not produce feminising factors.o The preferred name, complete androgen insensitivity syndrome CAIS reflects the underlying aetiology,o The cause of androgen insensitivity svndrome is the abnormality of the androgen receptor.o In the fetus with CAIS testes forms normally due to the presence of the SRY gene on chromosome Y.o At the appropriate time, these testes secretes anti Mullerian hormone leading to the regression of mullerian ducts. Hence CAIS women do not have a uterus.o Testosterone is also produced at the appropriate time. However due to the complete inability of the androgen receptor to respond, the external genitalia do not virilise and instead undergo female development.o These patients have vagina instead of penis.o Other areas where testosterone may have important fetal effects, such as hc brain, will also develop along the female path,o The result is a female both physically and psychologically with no uterus, testis present which is found at some point in their line of descent through the abdomen from the pelvis to the inguinal canal.o During puberty, breast development will be normal: however, the effects of androgens will not be seen, so pubic and axillary hair growth will be minimal.o Majority of women with CAIS have shortened vagina, when compared with normal average length of 10-12 cm.o The cause of this lies in the embroyological development of the vagina, Upper portion of vagina-develops from mullerian ducts Lower portion of vagina-develops from urogenital sinus. o In CAIS mullerian duct regresses, under the effect of mullerian inhibiting hormone, leaving just the part derived from the urogenital sinus.Clinical features of CAISo Female external genitaliao 46 xy karyotypeo Intrabdominal or inguinal testeso Absent uteruso Primary amenorrhoeao Reduced or absent sexual hair pubic and axillaryo Norma! breast developmento Vaginal hypoplasia 