Testicular adrenal rest tumors and Leydig and sertoli cell function in boys with classical congenital adrenal hyperplasia

Context: Infertility observed in adult males with congenital adrenal hyperplasia ( CAH) has been associated with testicular adrenal rest tumors ( TART) that may originate during childhood. Objective: Our objective was to describe the prevalence of TART and Sertoli and Leydig cell function in a group of boys aged 2-10 yr with CAH and to compare prevalence with that of a control group. Design: From August 2005 to January 2007, 19 patients with classical CAH ( CAH group) were referred from seven endocrinology centers. Methods: We studied 19 subjects in the CAH group and, as a control group, 13 boys from the community that did not have testicular diseases. A complete physical exam was performed. High-resolution ultrasound was used to determine TART prevalence. Inhibin B and anti-Mullerian hormone were used as Sertoli cell markers. The ratio between basal testosterone levels and testosterone levels 72 h after beta-human chorionic gonadotropin ( 5000 U/m(2)) treatment [( T-72 - T-0)/T-0] was used to evaluate Leydig cell response. Results: CAH and control groups were comparable in chronological age ( 5.9 vs. 5.6 yr; P = 0.67) and bone age/chronological age ratio ( 1.09 vs. 1.03; P = 0.09). TART prevalence was four of 19 ( 21%) in the CAH group. Lower values for inhibin B ( 49.2. vs. 65.2 pg/ml; P = 0.018), anti-Mullerian hormone 70.1 vs. 94.2 ng/ml; P = 0.002), and ( T-72 - T-0)/T-0 ( 5.6 vs. 13.6; P < 0.01) were observed in the CAH group. Conclusion: TART in prepubertal males with classic CAH could be found during childhood. We also report differences in markers of gonadal function in a subgroup of patients, especially in those with inadequate control.