[Diagnostic and therapeutic analysis of testicular adrenal rest tumor: A report of 21 cases].
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Objective The aim of this study is to explore the clinical characteristics, diagnostic methods and therapeutic strategies for testicular adrenal rest tumor (TART) and to provide evidence for optimizing clinical management. Methods Retrospective data collection was conducted on 21 TART patients diagnosed and treated in our hospital from June 2021 to March 2024. Clinical history, laboratory findings, imaging features were collected, and statistical analysis was performed on the differences in the maximum tumor diameter before and after the treatment. Results The cohort comprised 21 TART patients with a median age of 15 years, of whom 61.90% were pubertal or postpubertal. According to pathological staging, 2 cases (9.52%) were classified as stage Ⅱ, 16 cases (76.19%) as stage Ⅲ, and 3 cases (14.29%) as stage Ⅳ. A total of 95.24% had 21-hydroxylase deficiency, and 38.10% presented with infertility or skin hyperpigmentation as initial symptoms. Laboratory investigations revealed hypocortisolism, elevated adrenocorticotropic hormone (ACTH) and abnormal sex hormone levels in all patients, with 85.71% exhibiting increased progesterone, aldosterone and renin levels. Ultrasonography demonstrated bilateral testicular hypoechoic nodules in 100% of cases, with ill-defined margins in 80.95% and rich blood flow (grade Ⅱ or higher) in 95.24%. All patients received glucocorticoid therapy, resulting in a significant reduction in maximum tumor diameter (t=13.883, P=0.006 1). Normalization of sex hormone levels was achieved in 76.19% of patients. Notably, three patients with stage Ⅳ disease underwent adjunctive tumorectomy due to significant mass effect. Conclusions Early screening, diagnosis and treatment are critical for TART. Developing efficient diagnostic and therapeutic strategies is essential to preserve testicular function and quality of life.