Testicular adrenal rest tumours in congenital adrenal hyperplasia

Department of Paediatric Endocrinology, Radboud University Nijmegen Medical Centre, The Netherlands.
Best Practice & Research: Clinical Endocrinology & Metabolism (Impact Factor: 4.6). 05/2009; 23(2):209-20. DOI: 10.1016/j.beem.2008.09.007
Source: PubMed

ABSTRACT In adult patients with congenital adrenal hyperplasia (CAH) the presence of testicular adrenal rest tumours (TART) is an important cause of gonadal dysfunction and infertility. In the last decade several papers have focused on the origin and pathogenesis of these tumours. In this paper we review the embryological, histological, biochemical and clinical features of TART and discuss the treatment options. Furthermore, we propose a new five-stage classification of TART, based on sonographic, clinical and biochemical parameters, that may lead to a better follow up and treatment of patients with TART.

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Available from: Hedi Claahsen - van der Grinten, Aug 21, 2015
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    • "Poor hormonal control and inadequate suppression of ACTH secretion are dominant etiological factors in the development of TARTs. Early intensifying GC therapy may lead to tumor regression and prevent fertility problems in CAH males.[89] "
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    ABSTRACT: Congenital adrenal hyperplasia (CAH) describes a group of autosomal recessive disorders where there is impairment of cortisol biosynthesis. CAH due to 21-hydroxylase deficiency accounts for 95% of cases and shows a wide range of clinical severity. Glucocorticoid and mineralocorticoid replacement therapies are the mainstays of treatment of CAH. The optimal treatment for adults with CAH continues to be a challenge. Important long-term health issues for adults with CAH affect both men and women. These issues may either be due to the disease or to steroid treatment and may affect final height, fertility, cardiometabolic risk, bone metabolism, neuro-cognitive development and the quality-of-life. Patients with CAH should be regularly followed-up from childhood to adulthood by multidisciplinary teams who have knowledge of CAH. Optimal replacement therapy, close clinical and laboratory monitoring, early life-style interventions, early and regular fertility assessment and continuous psychological management are needed to improve outcome.
    10/2013; 17(Suppl1):S14-S17. DOI:10.4103/2230-8210.119491
    • "The reviewed prevalence of the TART surprisingly varies between 0% and 94%.[9] This wide range is attributed to variations between the studies in patient selection and detection methods. "
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    ABSTRACT: Congenital adrenal hyperplasia (CAH) refers to group of inherited diseases resulting from impaired adrenal steroidogenesis, and its most common cause is 21-hydroxylase deficiency. Testicular adrenal rest tumors (TARTs) are an important complication of CAH, which probably develop from ectopic remnants of intra-testicular adrenal tissue stimulated by Adrenocorticotropic hormone (ACTH) hypersecretion. These lesions are typically located within the rete testis and are bilateral, synchronous, nodular and multiple. TART usually, but not always, responses to suppressive medical therapy. TART leads to testicular structural damage, spermatogenesis disorders, infertility and most importantly, mass-forming lesions that could be mistaken for Leydig cell tumor (LCT). The later has a significantly different behavior with up to 10% of being malignant. Nowadays, due to advances in diagnosing and treating CAH, mass-forming TART is rarely encountered. As a result, there is the paucity in the medical literature regarding its features from pathological perspective. We herein present a case of mass-forming TART and we discuss the clinical, radiological, and morphological features as well as the major differential diagnosis of this rare lesion.
    04/2013; 3(1):15-9. DOI:10.4103/2231-0770.112789
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    • "They may sometimes significantly enlarge, mimicking testicular malignant tumors and leading to damage to the structure of testes, spermatogenesis disorders and infertility [1]. Until now, the diagnostics of TART have been based on a combination of clinical features (syndromes with hypercorticotropinemia), imaging methods (primarily two dimensional ultrasound e 2D US), response of the foci to glycocorticosteroid (GCS) therapy and exclusion of the neoplastic process [1] [2]. Although numerous investigations have been conducted, a specific marker useful in the diagnosis and precise identification of the nature of the TART tissue is still unknown. "
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    ABSTRACT: BACKGROUND: Testicular adrenal rest tumors (TART) are the nodular testicular lesions deriving from the adrenal remnant tissue reported in boys and men with congenital adrenal hyperplasia. Until now, the diagnostics of TART have been based on a combination of clinical features, imaging methods (primarily two dimensional ultrasound - 2D US), response of the foci to glycocorticosteroid (GCS) therapy and exclusion of the neoplastic process. Application of 2D US supplies however a limited range of information about the volume, demarcation, structure and vascularization of the lesions. OBJECTIVE: To define whether the use of 3D US, power Doppler and elastography changes the algorithm of the diagnostics and monitoring or treatment of TART. MATERIAL AND METHODS: In this study, modern ultrasound techniques such as 3D US and elastography were introduced in two boys with TART. RESULTS: The 3D power Doppler option gives the opportunity for accurate assessment of the volume of testes and adrenal tissue foci and their vascularization. Sonographic elastography allows the assessment of stiffness of adrenal tissue areas compared to normal testis parenchyma. CONCLUSION: The use of these modern techniques enables more adequate and advanced diagnostics, and more precise monitoring of the effects of treatment in patients with TART.
    Journal of pediatric urology 03/2013; 9(6). DOI:10.1016/j.jpurol.2013.02.008 · 0.90 Impact Factor
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