MON-254 MALIGNANCY RISK IN TURNER SYNDROME +Y, EARLY GONADECTOMY, AND THE ETHICS OF PARENTAL CHOICES

Abstract Disclosure: C. Ho: None. B. Earp: None. C. Kraus: None. M. Carpenter: None. D. Wilkinson: None. This case relates to an infant with Turner syndrome harboring the Y chromosome (TS+Y) and explores the boundaries of parental decision-making. Traditionally, gonads have been surgically removed in early childhood in this condition because of the risk of gonadoblastoma and potential malignant transformation. However, in the case discussed here, the infant’s parents do not wish for surgery. In other differences of sex development resulting in intersex traits (increasingly termed congenital Variations of Sex Characteristics; VSC), some institutions report a shift in the last decade away from early surgical management, in favor of allowing children to be involved in decision making when they are old enough to participate meaningfully. But should that approach change when there is a risk of malignancy? Unfortunately, there is a lack of good data to delineate this actual malignancy risk, largely due to the fact that historically, many of these gonads were removed. It is regarded by most that this risk becomes higher when the child becomes pubertal. Two commentaries are presented. One outlines ethical considerations around early surgery in the case of VSC, highlighting implications for the child’s bodily integrity and future sexual and reproductive autonomy. A second commentary analyzes the case in terms of pediatric ethics, medical uncertainty, and the zone of parental discretion. Both commentaries conclude that given a lack of adequate data to demonstrate net harms in delaying intervention, and some prospective benefit, it could be reasonable to defer surgery in accordance with the parental request. Though specifically concerning the condition of TS +Y, this discussion provides a framework to consider the ethical boundaries of parental decision-making when it comes to genital surgery in children who have VSC. Presentation: Monday, July 14, 2025