Testicular adrenal rests tumours in congenital adrenal hyperplasia: unraveling prevalence, risk factors and new therapeutic horizons in adolescents

Testicular adrenal rest tumours (TARTs) are benign intratesticular lesions occurring in males with classic congenital adrenal hyperplasia (CAH), with a prevalence ranging from 0% to 94% depending on age, disease severity and screening method. Although TARTs are non-malignant, their characteristic location can lead to compression of seminiferous tubules causing infertility. Adolescence represents a critical and particularly vulnerable window for TART development and progression. Besides ACTH chronic stimulation, which remains the main pathogenic driver, several other converging factors can contribute to suboptimal hormonal control and promote adrenal rest cell proliferation during adolescence. The aim of this minireview is to provide a comprehensive and updated overview of TARTs in the adolescent population, focusing on three key areas: prevalence across different CAH aetiologies, risk factors driving development and progression during puberty and emerging therapeutic approaches with potential impact on this complication.