Ultrasound diagnosis of testicular masses secondary to hyperplastic adrenal rests in a patient with adrenal insufficiency

Testicular Adrenal Rest Tumors in a Patient With Congenital Adrenal Hyperplasia

“…6 Increased corticotropin levels prevent involution of aberrant adrenal cortical cells that migrate with gonadal tissues in fetal life. 6,7 The testicular adrenal rests are usually less than 5 mm and can normally be found in the testis and surrounding tissues in 7.5% to 15% of neonates and 1.6% of adults. 4 In the face of uncontrolled CAH, this ectopic tissue may develop into adrenal rest tumors.…”

“…Hyperplastic adrenal cortical masses may be as large as 10 cm. 7 The adrenal rest tumors originate in the hilar region of the testicle and extend peripherally. They contain large cells that can resemble Leydig cells with abundant eosinophilic cytoplasm but lacking in Reinke crystalloids.…”

“…They contain large cells that can resemble Leydig cells with abundant eosinophilic cytoplasm but lacking in Reinke crystalloids. 7 Treatment with glucocorticoid replacement therapy can stabilize or repress these masses. 10 Histologically, the differential diagnosis includes Leydig cell hyperplasia, malignant lymphoma or plasmacytoma, prostate cancer metastasis, and malakoplakia.…”

Incidental Bilateral Leydig Cell Tumor of the Testes

“…Thus, when a Leydig cell tumor is suspected, adrenal glands should be examined [7][8][9]. The adrenal glands were normal in our case.…”

Testicular Adrenal Rests in Congenital Adrenal Hyperplasia

“…Histologically, testicular adrenal rests and Leydig cell tumor can appear similar, although testicular adrenal rests lack the characteristic Reinke crystalloid of Leydig cells. 6 Differentiation can sometimes be impossible; in truly equivocal cases, testicular vein sampling will reveal elevated cortisol levels compared with peripheral blood levels. Questioning the presence of testicular adrenal rests when clinically appropriate is critically important.…”