Intratesticular adrenal rests diagnosed by ultrasound

Adrenal rest tumors of the testes may occur in conditions associated with increased circulating adrenocorticotropic hormone (ACTH), including congenital adrenal hyperplasia (CAH) and Addison disease. Sonographically, these tumors appear as multiple round, hypoechoic nodules near the testicular hilus and are usually bilateral. They may undergo extensive fibrosis and become hyperechoic with acoustic shadowing. In the absence of excess ACTH or characteristic ultrasound findings, biopsy is recommended to exclude malignancy. Because malignant degeneration is very rare, close clinical and sonographic follow-up without biopsy is generally sufficient. Serial sonograms are useful to document stability or regression of tumor size during glucocorticoid replacement therapy.