A Young Man with Bilateral Testicular Pain and Swelling

Abstract

A 17-year-old male diagnosed with congenital adrenal hyperplasia (CAH) at the age of six months presented to the endocrine clinic with pain and swelling in both testes. When he was seven years old he developed signs of precocious puberty and was treated with triptorelin 3.75 mg (intramuscular) once a month between 2007 and 2011. He was asked to continue long-term treatment with hydrocortisone (three times daily) 10/5/5 mg and fludrocortisone 100 mg (once daily). However, he was not regular with his medication. Except for morbid obesity (body mass index = 51 kg/m2), his systemic examination was normal. Both testes were swollen and tender on palpation. Images of the ultrasound and Doppler of the left testes are shown. His 17-OH Progesterone level was 282.5 nmol/L. The ultrasound and doppler show hypoechoic areas with increased vascularity in both testes, suggesting the possibility of testicular adrenal rest tumors (TART) given that this patient is a known case of CAH. The elevated 17-OH Progesterone levels confirm that he has not been compliant with his medication. The first step would be to request him to take his medication regularly. We also have to address his obesity by advising him about diet and exercise.