Case: Twenty seven year old male presented to Urologist with heamospermia. He wa noted to have a lump in his scrotum. No evidence of infection. Ultrasound showed bilateral testicular tumours. Previous medical history of congenital adrenal hyperplasia and hypertension. Medication include Atenolol and Prednisolone (poor compliance). Non smoker. Very strong family h/o cancer. O/E bilateral upper pole testicular lumps 2 cm. firm, irregular. Tumour markers normal. All blood tests normal: serum testosterone 17 mmol/l. CT chest abdomen and pelvis showed grossly enlarged adrenal glands but nil else significant. Flexible cystoscopy: normal bladder.
Patient was posted unilateral orchidectomy (and biopsy) and sperm banking was arranged.
Patients case was discussed at MDTM and a referral to Endocrinologist made. It was concluded this was adrenal rest tissue and not primary testicular tumours. Orchidectomy was abandoned and patients glucocroticoid therapy intensified after counselling.
Further surveillance scans showed no increase in size of the tumours and patient is currently doing well on Prednisolone.
Discussion: Adrenal rest tissue is a rare but very important differential in any young person presenting with testicular masses. The importance of being aware of the previous medical history of CAH cannot be over-emphasized here. It would have been disastrous if this young man had an orchidectomy due to a case of mistaken identity, luckily this was avoided.