ABSTRACT
Testicular Adrenal Rest Tumors (TART) may play a role in fertility disturbances of patients with Classical Congenital Adrenal Hyperplasia (CAH). We report a 17 years old male with classical CAH, diagnosed in the newborn period due to a salt wasting crisis with dehydration and severe hyponatremia. He was treated with cortisol and fludrocortisone with a low adherence to therapy. He had a precocious puberty and accelerated bone age, and was treated with a luteinizing hormone releasing hormone (LHRH) analog during two years. At the age of 14 years, bilateral testicular masses were detected during the physical examination. Testicular color Doppler ultrasound showed the presence of TART. A new ultrasound at 17 years of age showed the persistence of adrenal rests and an abnormal testicular growth.
Subject(s)
Humans , Male , Adolescent , Adrenal Hyperplasia, Congenital/complications , Testicular Neoplasms/etiology , Testicular Neoplasms , Adrenal Rest Tumor/etiology , Adrenal Rest Tumor , Clinical Evolution , Infertility, Male/etiology , Testis/pathology , Testis , Ultrasonography, Doppler, ColorABSTRACT
Histoplasma capsulatum e um fungo universal dimorfico encontrado principalmente em solo contaminado com fezes de aves e morcegos. A apresentacao clinica inicial dos casos de histoplasmose disseminada raramente se caracteriza pela presenca de massas supra-renais bilaterais e insuficiencia adrenal por desnutricao tecidual importante. Por ser um agente oportunista existe maior susceptibilidade para os quadros de disseminacao naqueles pacientes com imunodeficiencia ou imunosupressao. Nos relatamos um caso de uma paciente idosa e diabetica com aumento bilateral das supra-renais e apresentacao clinica vaga, sendo feito o diagnostico de histoplasmose disseminada apenas apos a exploracao cirurgica das supra-renais. Possivelmente se passaram 60 anos entre a infeccao primaria e o inicio dos sintomas. O tratamento foi realizado com uso de itraconazol