Testicular torsion with synchronous adrenal rest tumors in a patient with congenital adrenal hyperplasia

This is the case report of a 20-year-old male patient who was admitted to our clinic with a sudden onset of severe left testicular pain. Color Doppler ultrasonography revealed normal vascular supply of both testes nevertheless, but when compared with the right testis, the axis of the left testicular cord was located more posteriorly and along with swelling of the epididymis made the diagnosis of partial torsion highly probable. Bilaterally hypervascularized testicular and epididymal solid masses (up to 20 mm) were also present. Reposition of the left testicle followed by warm sponge compress was performed. The patient was suffering from congenital adrenal hyperplasia (CAH) and he was in steroid replacement therapy all his life. Testicular adrenal rest tumor is an important complication of classical CAH due to 21-hydroxylase deficiency that can potentially lead to gonadal dysfunction and infertility in adulthood. If the presence of enlarged testicular rest tumor deteriorates the stability of the testicular cord stability and renders the testis more vulnerable to torsion is a hypothesis that is hard to prove since these tumors are rare and torsion in these patients is even rarer. Nevertheless, the physicians must be aware of this condition and its benign course in order to correctly differentiate it from other diseases and avoid more radical procedures.