Bilateral testicular enlargement due to adrenal remnant in a patient with C11 hydroxylase deficiency congenital adrenal hyperplasia.

The case of a 15-yr-old boy with C11 hydroxylase deficiency congenital adrenal hyperplasia is reported who was diagnosed and treated as true precocious puberty at the age of 2 yr because of virilization and bilateral testicular enlargement. He later developed hyperpigmentation, hypertension and short stature and because of an increase in testes size he underwent testicular biopsy with the assumption of Leydig cell tumor. With the intake of glucocorticoids his testes size, hypertension and hyperpigmentation improved markedly. We could find only 6 such cases in the literature and have reviewed their clinical and laboratory data. All patients showed the picture of virilization with hypertension. Leydig cell tumor was proposed as the differential diagnosis in all cases except ours. Ultrasonography was able to show testicular adrenal-like tissue in all those in whom the procedure was undertaken. In the 5 patients of whom we could find enough data, 1 responded partially and 4 responded markedly to corticosteroid therapy with shrinkage of testicular tumors. We conclude that clinical findings and US are very important in the early diagnosis of these patients and with adequate treatment most cases show shrinkage in testicular tumors.

Supportive care is not the only option in prostate cancer patients resistant to hormone therapy: the argument against.

Hormone-resistant prostate cancer patients are elderly, frail and in pain. They have a median survival of 6 months. There is no convincing evidence from controlled trials that anything we do will increase life expectancy. Any attempt to do so with currently available agents may either kill them earlier or decrease the quality of the short life left to them. The alternatives for management include the simple, non-toxic, supportive measures of better analgesic use, antiandrogen withdrawal, external beam radiation and steroids, which can produce significant symptomatic improvement. There is little evidence that the benefits of more aggressive therapy exceed those achieved with supportive care.