Testicular adrenal rests
Citation, DOI, disclosures and article data
At the time the article was created The Radswiki had no recorded disclosures.
View The Radswiki's current disclosuresAt the time the article was last revised Arlene Campos had no financial relationships to ineligible companies to disclose.
View Arlene Campos's current disclosures- Testicular adrenal rests
- Testicular adrenal rest
- Testicular adrenal rest tumour (TART)
- Testicular adrenal rest tissue
- Testicular tumour of the adrenogenital syndrome
- Testicular adrenal-like tissue
Testicular adrenal rests are a rare cause of a testicular mass.
On this page:
Terminology
Testicular adrenal rests can be known by a variety of terms 2:
testicular adrenal rest tumor (TART)
testicular adrenal rest tissue
testicular tumor of the adrenogenital syndrome
testicular adrenal-like tissue
Epidemiology
Can be found in the testis and surrounding tissues in 7.5-15% of newborns and ~1.5% of adults.
Clinical presentation
Usually, adrenal rests are asymptomatic. If these cells are exposed to elevated levels of adrenocorticotropic hormone, they can enlarge to form masses. They are associated with patients with congenital adrenal hyperplasia and rarely in patients with Cushing syndrome.
Pathology
Aberrant adrenal rests represent collections of cells that have become trapped within the developing gonad during fetal development. The rests are usually <5 mm.
ADVERTISEMENT: Supporters see fewer/no ads
Radiographic features
Ultrasound
As with evaluation of 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. Variable vascularity on color Doppler has been reported, being hypovascular rather than hypervascular 4.
MRI
T1: iso- or slight hyperintense signal
T2: hypointense signal
DWI: no diffusion restriction
T1 C+ (Gd): avid homogeneous post-contrast enhancement
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 stabilization or regression of the masses.
ADVERTISEMENT: Supporters see fewer/no ads
Differential diagnoses
References
- 1. Woodward P, Sohaey R, O’Donoghue M, Green D. From the Archives of the AFIP. Radiographics. 2002;22(1):189-216. doi:10.1148/radiographics.22.1.g02ja14189 - Pubmed
- 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
- 3. Engels M, Span P, van Herwaarden A, Sweep F, Stikkelbroeck N, Claahsen-van der Grinten H. Testicular Adrenal Rest Tumors: Current Insights on Prevalence, Characteristics, Origin, and Treatment. Endocr Rev. 2019;40(4):973-87. doi:10.1210/er.2018-00258
- 4. Yılmaz R, Şahin D, Aghayev A et al. Sonography and Magnetic Resonance Imaging Characteristics of Testicular Adrenal Rest Tumors. Pol J Radiol. 2018;82:583-8. doi:10.12659/pjr.901986 - Pubmed
Incoming Links
- Testicular adrenal rests
- Testicular adrenal rest tumour (TART)
- Congenital adrenal hyperplasia with testicular adrenal rest tumor (TART)
- Testicular adrenal rest tumor (TART)
- Adrenal rests
- Testicular adrenal rest tumor (TART)
- Staging of testicular adrenal rest tumor (TART)
- Testicular adrenal rest tumor (TART)
- Testicular adrenal rests
- Testicular adrenal rest tumours
Related articles: Pathology: Genitourinary
- obstetrics
-
first trimester
- ultrasound findings in early pregnancy
- embryo/fetus
- beta-hCG levels
- confirming intrauterine gestation
- pregnancy of unknown location (PUL)
- first trimester vaginal bleeding
- early structural scan
- aneuploidy testing
-
second trimester
- fetal biometry
- amniotic fluid volume
- fetal morphology assessment
- soft markers
- amnioreduction
- Doppler ultrasound
- nuchal translucency
- 11-13 weeks antenatal scan
- chorionic villus sampling (CVS) and amniocentesis
- other
- placenta
- placental anatomy
- placental developmental abnormalities
- placenta previa
- spectrum of abnormal placental villous adherence
- abnormalities of cord insertion
- abruptio placentae
- placental pathology
- vascular pathologies of placenta
- placental infections
- placental masses
- molar pregnancy
- twin placenta
- miscellaneous
-
first trimester
- gynecology
- acute pelvic pain
- chronic pelvic pain
- uterus
- ovaries
- ovarian follicle
- ovarian torsion
- pelvic inflammatory disease
- ovarian cysts and masses
- paraovarian cyst
- polycystic ovaries
- ovarian hyperstimulation syndrome
- post-hysterectomy ovary
- cervix
- fallopian tube
- other
- male genital tract
- prostate gland
- transrectal ultrasound
- prostate tumors
- infections of the prostate
-
prostatitis
- acute bacterial prostatitis
-
chronic prostatitis
- chronic bacterial prostatitis
- chronic prostatitis and chronic pelvic pain syndrome (CPPS)
- asymptomatic inflammatory prostatitis
- granulomatous prostatitis
- emphysematous prostatitis
- prostatic abscess
-
prostatitis
- benign prostatic hypertrophy
- cystic lesions of the prostate
- prostatic calcification
- prostatic infarction
- testes
-
unilateral testicular lesion
- testicular torsion
- orchitis
- testicular trauma
-
germ cell tumors of the testis
- testicular seminoma
-
non seminomatous germ cell tumors
- mixed germ cell tumor
- yolk sac tumor (endodermal sinus tumor)
- embryonal cell carcinoma
- choriocarcinoma
- testicular teratoma
- testicular epidermoid (teratoma with ectodermal elements only)
- burned out testis tumor
- sex cord / stromal tumors of the testis
- testicular cyst
- testicular lymphoma
- bilateral testicular lesion
- paratesticular lesions
- epididymis
- other
- polyorchidism
- cryptorchidism
- tubular ectasia of the rete testis
- cystadenoma of the rete testis
- testicular sarcoidosis
- testicular tuberculosis
- spermatic cord
- fibrous pseudotumor of the scrotum
- scrotal leiomyosarcoma
- testicular adrenal rest tumors (TARTs)
- tunica vaginalis testis mesothelioma
- splenogonadal fusion
- testicular vasculitis
- abnormal testicular Doppler flow (differential)
-
unilateral testicular lesion
- penis
- prostate gland
- KUB
- kidneys
- normal renal anatomy
- hydronephrosis
- urolithiasis
- renal masses
- renal cystic disease
- renal infection
- vascular
- trauma
- ureter
- normal ureter anatomy
- ureteral stricture
- ureteral dilatation
- ureteral anomalies
- ureteral tumors
- ureteral trauma
- other
- bladder
- kidneys