Answer of October 2007


Clinical History:

A 10-year-old boy with history of congenital adrenal hyperplasia on steroid replacement therapy. Found to have bilateral testicular masses.

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Testicular adrenal rest tumors.


Testicular adrenal rest tumors can be the first manifestation of congenital adrenal hyperplaisa . It may be misdiagnosed as Leydig Cell tumor. In one study, 18% of young males presenting with bilateral testicular masses to urology were found to have undiagnosed CAH. The following points favours testicular adrenal rest tumors: 1.Young age, 2. Bilaterality, 3. Located at mediastinum. Does not distort the contour of the testis, 4. Absence of metastases, 5. Decrease in size with glucocorticoid therapy, 6. Biochemical Ix and DNA analysis to confirm CAH..