Testicular adrenal rest tumors in boys with congenital adrenal hyperplasia: 3D US and elastography – Do we get more information for diagnosis and monitoring?

• Published in: Journal of pediatric urology 2013-12, Vol.9 (6), p.1032-1037
• Main Authors: Jedrzejewski, Grzegorz, Ben-Skowronek, Iwona, Wozniak, Magdalena Maria, Brodzisz, Agnieszka, Budzynska, Elzbieta, Wieczorek, Andrzej Pawel
• Format: Article
• Language: English
• Subjects: 3D US; Adolescent; Adrenal Hyperplasia, Congenital - diagnostic imaging; Adrenal rest; Adrenal Rest Tumor - congenital; Adrenal Rest Tumor - diagnostic imaging; Anti-Inflammatory Agents - administration & dosage; Dexamethasone - administration & dosage; Drug Monitoring - methods; Elasticity Imaging Techniques - methods; Elastography; Fludrocortisone - administration & dosage; Glucocorticoids - administration & dosage; Humans; Hydrocortisone - administration & dosage; Male; Pediatrics; Testicular Neoplasms - congenital; Testicular Neoplasms - diagnostic imaging; Testis - blood supply; Testis - diagnostic imaging; Ultrasonography, Doppler - methods; Urology; Vascularization index
• ISSN: 1477-5131; 1873-4898
• DOI: 10.1016/j.jpurol.2013.02.008

Abstract Background Testicular adrenal rest tumors (TART) are the nodular testicular lesions deriving from the adrenal remnant tissue reported in boys and men with congenital adrenal hyperplasia. Until now, the diagnostics of TART have been based on a combination of clinical features, imaging methods (primarily two dimensional ultrasound – 2D US), response of the foci to glycocorticosteroid (GCS) therapy and exclusion of the neoplastic process. Application of 2D US supplies however a limited range of information about the volume, demarcation, structure and vascularization of the lesions. Objective To define whether the use of 3D US, power Doppler and elastography changes the algorithm of the diagnostics and monitoring or treatment of TART. Material and methods In this study, modern ultrasound techniques such as 3D US and elastography were introduced in two boys with TART. Results The 3D power Doppler option gives the opportunity for accurate assessment of the volume of testes and adrenal tissue foci and their vascularization. Sonographic elastography allows the assessment of stiffness of adrenal tissue areas compared to normal testis parenchyma. Conclusion The use of these modern techniques enables more adequate and advanced diagnostics, and more precise monitoring of the effects of treatment in patients with TART.