GONADAL AND ADRENAL CATHETERIZATION DURING ADRENAL SUPPRESSION AND GONADAL STIMULATION IN A PATIENT WITH BILATERAL TESTICULAR-TUMORS AND CONGENITAL ADRENAL-HYPERPLASIA

We report the case of a patient with bilateral testicular tumors and c ongenital adrenal hyperplasia due to al-hydroxylase deficiency. Cathet erization of the left testicular and adrenal veins was performed. The presence of 11 beta-hydroxylated steroids in the spermatic veins confi rmed the presence of testicular tumor secondary to adrenal rest cells. After adrenal suppression by dexamethasone combined with gonadal stim ulation with hCG, a dramatic decrease in androgens and adrenal steroid s was observed in the peripheral blood. Compared to the periphery, 21- deoxycortisol and 11 beta-hydroxy-Delta(4)-androstenedione levels rema ined higher than that of 21-deoxycorticosterone in the gonadal vein, b ut not in the adrenal vein, which seems to indicate that the nature of this ectopic tissue is unusual and that its sensitivity to dexamethas one depends on the adrenocortical zones. No rise in estradiol or testo sterone was obtained after hCG stimulation, suggesting that all of the testicular tissue was inactive or destroyed. This finding was confirm ed by histological examination.