Ricerc@Sapienza

Testicular adrenal rest tumors (TARTs) are a common cause of gonadal dysfunction and infertility in patients with congenital adrenal hyperplasia (CAH), with a prevalence ranging from 14 to 86%.Their origin has been recently traced to a population of adrenal-like pluripotent stem cells deriving from the urogenital ridge,which undergo adrenal differentiation and proliferation if subjected to high levels of ACTH.TARTs can affect gonadal function by direct compression on the seminiferous tubules, often resulting in obstructive azoospermia, and by altering the intratesticular hormonal environment via paracrine androgen secretion.The diagnosis is mainly made via testicular US but requires timely differentiation from morphologically similar lesions, such as germline and Leydig cell tumors.Suggested medical treatment for TARTs is based on high-dose, long-acting glucocorticoids (HD-GC) which improves semen parameters and reduce the tumor size in some cases, but not in others.On the other hand,HD-GC retain well-known side-effects, such as weight gain, metabolic impairment, bone loss, hypertension. No predictors for clinical response to GC treatment has been identified.There is no universal consensus about steroid formulation, dose or administration time with proved effects on TARTs and current indication derive from case reports or small series.The management of CAH in subjects with TARTs requires a tailored approach, with ultrasound screening starting from childhood and andrological counseling regarding the possibility of preserving fertility through cryopreservation.Based on these premises,the present study will therefore aim to prospectively compare the safety profile and the efficacy of different glucocorticoid formulations in decreasing TART size, as well as to evaluate their impact on seminal and hormonal parameters over a 6-months period.Moreover, new electrochemical sensors for sensitive and fast detection of cortisol will be realized, tested in human plasma samples.