Testicular Adrenal Rest Tumour (TART) or Testicular Malignancy: A Clinical Dilemma

Testicular adrenal rest tumour (TART) is a known entity in patients with congenital adrenal hyperplasia. An adult patient presenting with testicular enlargement raises a concern for malignancy and this creates a diagnostic dilemma between non-malignant conditions such as TART versus testicular malignancy. We describe a case where the patient underwent orchiectomy due to clinical concern for malignancy but, retrospectively, this outcome could have been prevented by medical treatment. This case emphasises the need to learn from errors. There is a need to increase awareness of the condition among medical professionals to reduce the chances of unnecessary surgical intervention. LEARNING POINTS: To recognize testicular adrenal rest tumour (TART) as cause of testicular enlargement in adult patients with congenital adrenal hyperplasia. To differentiate TART from other types of testicular malignancy. Consider medical treatment with exogenous glucocorticoid and mineralocorticoid replacement to prevent unnecessary surgical intervention.