ESPE Abstracts

Introduction: Testicular adrenal rest tumour (TART) is a complication in males with congenital adrenal hyperplasia (CAH). However, the prevalence, risk factors and treatment in children are not clear.

Objective: 1) To identify the incidence of TART and risk factors in patients with classical CAH in our centre 2) To study the clinical characteristics, hormonal profile, treatment interventions and outcome of patients with TART.

Methods: Testicular ultrasound were performed in 16 patients with poorly controlled CAH (mean age 9.87 ± 3.11, range 4.67-16yrs). Clinical characteristics, hormonal profiles and treatment were compared between patients with and without TART.

Results: TART lesions were detected by ultrasound in 6 patients (37.5%). The lesions were bilateral in all patients, mean diameter of 0.3cm, hypoechoic in nature and scarce in vascularity. Interestingly, testicular microlithiasis was found coincidently in one patient. There was no significant difference in height SDS and BMI SDS in patients with and without TART. TARTs were detected in 60% of patients who had attained final height. Only 1 patient had palpable nodules. The 17-hydroxyprogesterone level was higher in CAH patients with TART (322.22 ± 238.87nmol/l) than in patients without TART (149.61 ± 201.20nmol/l). Poor compliance was identified in 5 patients. 5 patients developed peripheral precocious puberty and two patients evolved into central precocious puberty. All patients were on hydrocortisone and fludrocortisone replacement. All had intensified hydrocortisone regimen after detection of TART (mean dose 17.3mg/m²/day) for 2-4 weeks, however only two had resolution of TART on repeated ultrasound.

Conclusions: Ultrasound of testes should be routinely performed in childhood, especially in those with poor disease control and at peri-pubertal age. Larger studies should be conducted to explore the risk factors and therapeutic modalities in TART.