Endocrine Abstracts

Introduction: Intra-testicular adrenal inclusions (ISIT) are benign tumors made of ectopic adrenal cortex tissue hyper stimulated by ACTH in excess. All pathologies causing a rise ACTH levels may be associated with adrenal inclusions. They are found mainly in patients with congenital adrenal hyperplasia (CAH) of untreated or poorly treated.

Objective: Search the frequency of ISIT in CAH and clarify clinical and progressive characteristics.

Materials and methods: Forty patients with CAH responsible adrenal insufficiency (35 in 21 and one in five hydroxylase) underwent testicular echo-Doppler in search of ISIT. The volume of each testicle, the presence of ISIT, their size, echogenicity, and vascularity at diagnosis and during follow up.

Results: Adrenal inclusions were found in ten patients (25%). They were asymptomatic and bilateral in all case. Doppler ultrasound was suggestive in all patients (hilar localisation, mitigating but not calcified appearance, vascular architecture preserved). Partial regression after glucocorticoid treatment was noted in 95% of cases. In two cases the adrenal inclusion continued to grow requiring orchidéctomie. Histological study was in favour of a Leydig cell tumours.

Discussion and conclusion: ISIT are common in CAH (between 27 and 94%). Related to chronic stimulation by ACTH, they often reflect an insufficient suppressive treatment with glucocorticoid. The Doppler allows the characterisation. They must be systematically sought and monitored. They usually regress or stabilise with replacement glucocorticoid treatment. Sometimes they can grow, while raising the problem of the histological nature and risk of subfertility related to the mass effect of the ISIT and toxic effects of adrenal steroids and hypogonadotropic hypogonadism.