Steroidogenesis in Pediatric Adrenal Rests in the Spermatic Cord

To evaluate steroidogenesis in pediatric adrenal rests in the spermatic cord.

We reviewed pediatric patients who underwent surgical exploration of the inguinal and scrotal areas retrospectively. When we detected spermatic cord masses during the surgery, we resected it for pathological evaluation.

We first reviewed clinical records of 249 surgeries in 194 male patients in the retrospective fashion and subsequently detected ten adrenal rests in nine cases. Steroid synthases, androgen receptor, Ki-67 were immunolocalized in nine cases to further explore steroidogenesis and potential effects of androgens. All adrenal rests harbored multiple zonae as in eutopic adrenal cortex with fetal adrenal cortex detected in four-fifth adrenal rests in infancy but none after infancy. Age was significantly negatively correlated with adrenocortical areas evaluated by image analysis (P < 0.0001). Immunoreactivity of aldosterone synthase (CYP11B2), 11-beta-hydroxylase, cytochrome P450 17A1, and sulfotransferase 2A1 was diffusely detected mainly in the areas corresponding to the zona glomerulosa (ZG), the zona fasciculata (ZF), the ZF and zona reticularis, and the zona reticularis and fetal adrenal cortex-like structures, respectively. CYP11B2-positive area ratio tended to decrease from birth to early childhood but increase in prepuberty. Diffuse cytoplasmic androgen receptor immunoreactivity was detected in ZG-like cells in prepubertal specimens. Ki-67 positive cells were mainly detected in the ZG- and ZF-like cells, mostly in infancy.

Androgen-dependent aldosterone biosynthesis may differ between adrenal rests and eutopic adrenal glands, but steroidogenesis in adrenal rests in the spermatic cord is considered normal.