An evaluation of the risk factors for orchidism and the efficacy of intensive corticosteroids therapy for the complicating testicular adrenal rest tumors in the patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency during the childhood and pubescent stages

Abstract

Objective To explore the risk factors for orchidism and the curative efficacy of intensive corticosteroids therapy for the testicular adrenal rest tumors (TART) in the patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency (21OHD) during childhood and pubescent periods. Methods A total 12 cases (27 case-times) with TART were adopted in intensive corticosteroids therapy, 7 cases (7case-times) as control group without intensive therapy. Retrospective analysis following parameters: (1) The testicular volume and the echogenic characteristics of TART by B-mode ultrasound. (2) Serum levels of FSH, LH, testosterone, 17-hydroxyprogesterone, androstendion, and inhibin-B were measured. (3) Orchidism was defined by one of following events: serum level of inhibin-B≤3rd % for normal, and(or) serum level of testosterone<1.42 ng/ml for the individual which is already in Tanner Ⅳ stage. (4) The relationship between regression of TART and intensive therapy project. Results The prevalence of TART in 21-OHD was 28.18% during 2-18 years old, and the youngest age with TART was 2.48 year of old. The regression rate of TART by intensive therapy was higher than that of the control significantly, 20/30 and 1/11(tumor-times) respectively(P=0.004). When the dose of dexamethasone ≥30% of total doses of corticosteroids, the regression rate of TART was higher than those less than 30% ones, or adopted hydrocortisone alone, were both respectively 16/20 and 4/10(P=0.045). The risk factors for orchidism related to early diagnosis: The TARTs stages in diagnosis (≥stages III; P=0.003), the tumor in size, hyperechogenicity in B ultrasound of the tumors(P=0.003). Inhibin-B is the earliest displayed biochemical warker for orchidism. Conclusions The TART could regress when got early diagnosis and adopted intensive corticosteroids therapy on time. Delayed diagnosis was the main risk factor for orchidism. For early diagnosis of TART, we suggest to conduct the scrotal ultrasound regularly started from 2 years of age. Key words: Congenital adrenal hyperplasia; 21-hydroxylase deficiency; Childhood and pubescent; Testicular adrenal rest tumors; Intensive corticosteroids therapy; Orchidism