Imaging Spectrum and Surveillance of Testicular Adrenal Rest Tumours in Congenital Adrenal Hyperplasia: A Case Series.

Testicular adrenal rest tumours are an important and potentially reversible complication of congenital adrenal hyperplasia caused by chronic adrenocorticotropic hormone stimulation of ectopic adrenal tissue. Delayed diagnosis can result in irreversible testicular damage and infertility, underscoring the need for early detection. We present a case report of three patients with biochemically confirmed congenital adrenal hyperplasia across different age groups who underwent scrotal ultrasound evaluation at a tertiary care centre. A 32-year-old man presenting with infertility demonstrated bilateral mediastinal hypoechoic lesions with internal vascularity and reduced testicular volumes, consistent with advanced Stage III disease. An 18-year-old man showed bilateral early nodular lesions corresponding to Stage II disease with preserved testicular morphology. A nine-year-old boy demonstrated no detectable intratesticular lesions despite biochemical disease, representing preclinical Stage I involvement. These findings illustrate a continuous, age-dependent imaging spectrum of testicular adrenal rest tumours. Scrotal ultrasound is a sensitive and practical modality for early detection, staging, and longitudinal monitoring. Recognition of this progression enables timely intervention and may prevent progression to infertility.