Scrotal Ultrasonography Features of Testicular Adrenal Rest Tumors in Male Congenital Adrenal Hyperplasia Patients: A Systematic Review.

Abstract

Introduction: Testicular Adrenal Rest Tumors (TART) is one of the complications in male Congenital Adrenal Hyperplasia (CAH) patients that need early detection using scrotal ultrasonography. This systematic review aims to provide an up-to-date summary of the current understanding of scrotal ultrasonography features of testicular adrenal rest tumors in male congenital adrenal hyperplasia patients to help medical professionals diagnose TART in male CAH patients.

Methods: A systematic review was conducted using the PRISMA methodology. The authors searched for studies through PubMed from the last ten years until August 2023. Male CAH patients diagnosed by clinical and hormonal examination or genetic analysis with at least one of the features of TART in scrotal ultrasonography were included.

Results: This systematic review involved fourteen studies that were classified into retrospective cohort study (n = 5), cross-sectional study (n = 4), and prospective cohort study (n = 5). The total number of participants from fourteen studies was 597 patients, and 186 patients were found to have TART (31.16%). Studies showed that bilateral lesions (78.49%), lesions located near the mediastinum testes (89.61%), hypoechoic (81.94%), clear border (76.74%), round to oval lesions (44.44%, 55.56%, respectively), and hypervascular (69.39%) in color doppler ultrasound were found in male CAH patients with TART.

Conclusion: Scrotal ultrasonography features of TART in male CAH patients were primarily bilateral, located near the mediastinum testes, hypoechoic, clear border, round to oval shape, and hypervascular in color Doppler ultrasound.