Beyond malignancy: recognising testicular adrenal rest tumours

Abstract

Background: Testicular adrenal rest tumours (TART) are sporadic testicular masses mainly occurring in individuals with congenital adrenal hyperplasia (CAH) due to stimulation by adrenocorticotropic hormone (ACTH).^1,2 If not detected early, these masses can lead to testicular dysfunction and infertility.^1,3 This report presents two cases of TARTs, one in a child and another in an adult, highlighting differences in clinical presentation, diagnostic challenges, and management approaches.

Methods: Both cases with established CAH presented with testicular masses, which were diagnosed through a combination of clinical evaluation, hormonal profiling, and testicular ultrasound. Management focused on optimisation of glucocorticoid therapy and regular follow-up to monitor tumour progression and prevent unnecessary surgical procedures.

Results: In both cases, TARTs were confirmed. The paediatric patient had an early-stage TART with preserved testicular function, whereas the adult patient exhibited impaired testicular function with elevated ACTH levels. Following improvement in glucocorticoid therapy, the paediatric patient showed a decrease in tumour size, while the adult patient showed a stable tumour size with no further decline in testicular function. Surgical intervention was not required for either patient, emphasising the significance of early diagnosis and management in preventing long-term complications.

Conclusion: Early detection and optimised glucocorticoid therapy are critical in managing TARTs in CAH. Well-timed intervention can protect testicular function and prevent complications, emphasising the need for regular monitoring and clinical awareness.