Testicular enlargement in a pre-pubertal boy with adrenocortical tumour

Adrenocortical tumours are rare in children. Virilisation caused by overproduction of adrenal androgens is the most common presentation. The testes of pre-pubertal boys with this tumour are usually small or of pre-pubertal size. A 4.8-year-old boy with an adrenocortical tumour and symmetrical pubertal-sized testes is reported. The serum testosterone level was 204 nmol/L (<0.7), dehydro-epiandrosterone-sulphate 56.7 μmol/L (<1.5) and luteinising and follicle-stimulating hormones were at suppressed levels. Histology demonstrated a diffusely increased mean tubular diameter of 90 μm (the size in a 12-year-old boy) and hyperplasia of Sertoli cells. There were no Leydig cells in the interstitial area. Prolonged exposure to an extraordinarily high testosterone level could have had stimulating effects on the seminiferous tubules and Sertoli cell growth and thus contributed to testicular enlargement.