Testicular adrenal rests
Testicular adrenal rests are a rare cause of a testicular mass.
Testicular adrenal rests can be known by a variety of terms 2:
- testicular adrenal rest tumour (TART)
- testicular adrenal rest tissue
- testicular tumour of the adrenogenital syndrome
- testicular adrenal-like tissue
Can be found in the testis and surrounding tissues in 7.5-15% of newborns and ~1.5% of adults.
Usually, adrenal rests are asymptomatic. If these cells are exposed to elevated levels of adrenocorticotropic hormone, they can enlarge to form masses. They can be clinically identified in patients with congenital adrenal hyperplasia and rarely in patients with Cushing syndrome.
Aberrant adrenal rests represent collections of cells that have become trapped within the developing gonad during fetal development. They are usually less than 5 mm.
As with evaluating other testicular pathology, ultrasound is the modality of choice.
The sonographic appearance of adrenal rests is variable, with some series describing predominantly hypoechoic masses and others reporting heterogeneously hyperechoic masses with shadowing. Lesions are typically multiple, bilateral, and eccentrically located, usually within the mediastinum testis.
Treatment and prognosis
It is important to suggest this in the differential diagnosis in the appropriate setting as they are benign lesions and unnecessary orchiectomy can be avoided. Appropriate hormone serum bloodwork can help secure the diagnosis.
Treatment with glucocorticoid replacement therapy results in stabilisation or regression of the masses.
Ultrasound - testicular and scrotal
- ultrasound (introduction)
testicular and scrotal ultrasound
unilateral testicular lesion
- testicular torsion
- testicular rupture
- germ cell tumours of the testis
- sex cord / stromal tumours of the testis
- bilateral testicular lesion
- paratesticular lesions
- tubular ectasia of the rete testis
- cystadenoma of the rete testis
- testicular sarcoidosis
- testicular tuberculosis
- spermatic cord
- fibrous pseudotumour of the scrotum
- scrotal leiomyosarcoma
- testicular adrenal rest tumours (TARTs)
- tunica vaginalis testis mesothelioma
- splenogonadal fusion
- unilateral testicular lesion
- 1. Paula J. Woodward, Roya Sohaey, Michael J. O’Donoghue, and Douglas E. Green. From the Archives of the AFIP: Tumors and Tumorlike Lesions of the Testis: Radiologic-Pathologic Correlation. RadioGraphics 2002 22: 189-216.
- 2. Avila NA, Shawker TS, Jones JV, Cutler GB, Merke DP. Testicular adrenal rest tissue in congenital adrenal hyperplasia: serial sonographic and clinical findings. AJR. American journal of roentgenology. 172 (5): 1235-8. doi:10.2214/ajr.172.5.10227495 - Pubmed