Unilateral testicular enlargement in a teenager with Beckwith-Wiedemann syndrome: a case report

"Management of andrological disorders from childhood and adolescence to transition age: guidelines from the Italian Society of Andrology and Sexual Medicine (SIAMS) in collaboration with the Italian Society for Pediatric Endocrinology and Diabetology (SIEDP)-Part-1"

PURPOSE

Andrological pathologies in the adulthood are often the results of conditions that originate during childhood and adolescence and sometimes even during gestation and neonatal period. Unfortunately, the reports in the literature concerning pediatric andrological diseases are scares and mainly concerning single issues. Furthermore, no shared position statement are so far available.

METHODS

The Italian Society of Andrology and Sexual Medicine (SIAMS) commissioned an expert task force involving the Italian Society of Pediatric Endocrinology and Diabetology (SIEDP) to provide an updated guideline on the diagnosis and management of andrological disorders from childhood and adolescence to transition age. Derived recommendations were based on the grading of recommendations, assessment, development, and evaluation (GRADE) system.

RESULTS

A literature search of articles in English for the term "varicoceles", "gynecomastia", "fertility preservation", "macroorchidism", "precocious puberty" and "pubertal delay" has been performed. Three major aspects for each considered disorder were assessed including diagnosis, clinical management, and treatment. Recommendations and suggestions have been provided for each of the mentioned andrological disorders.

CONCLUSIONS

These are the first guidelines based on a multidisciplinary approach that involves important societies related to the field of andrological medicine from pediatric to transition and adult ages. This fruitful discussion allowed for a general agreement on several recommendations and suggestions to be reached, which can support all stakeholders in improving andrological and general health of the transitional age.

Diffusion‐weighted imaging and conventional magnetic resonance imaging for detection of non-palpable undescended testis

Background

MRI is noninvasive imaging tool and does not imply ionizing radiation and applies multiplanes images, but it is sometimes less efficient in locating intraabdominal functioning testicles and it fails to locate most of the atrophied testicles. Our aim in this study was to assess the value of the combined conventional MR imaging and DWI in the detection of non-palpable undescended testes in pediatric patients and correlate the results with the laparoscopic finding.

Results

This prospective study was carried out from January 2020 to February 2022 on 60 pediatric patients with 68 non-palpable undescended testes referred from Urology department to the radiodiagnosis and medical imaging department at our institute for MR imaging evaluation of clinically diagnosed non-palpable undescended testis, and their age ranged from 6 months to 17 years with mean age of 4.24 ± 4.67 years. The conventional MRI sensitivity was 85.71%, specificity was 100%, NPV was 60%, and PPV was 100% with accuracy of 88.23%. The combined DWI and MRI sensitivity was 92.86%, specificity was 100%, NPV was 75%, and PPV was 100% with accuracy of 94.12%. DWI was able to detect all viable abdominal testes, while only detecting 26 (out of 28) inguinal testes. Combined assessment was able to detect all viable abdominal and inguinal testes.

Conclusions

Combined DWI with a high b value and conventional MRI including T1WI, T2WI and fat-suppression T2WI showed considerable diagnostic performance compared to conventional MRI alone improving the preoperative sensitivity and accuracy of detection of non-palpable undescended testes.

Adrenal cytomegaly with elevated serum androgen levels in a patient with Beckwith-Wiedemann syndrome

Beckwith-Wiedemann syndrome (BWS) is infrequently associated with adrenocortical carcinoma (ACC) or non-hormone-producing adrenal cytomegaly, but we recently, encountered a single case of adrenal cytomegaly in a patient with BWS, which was difficult to distinguish from androgen-producing adrenocortical carcinoma (ACC). Here, we describe the case of a 4-month-old female who presented with clitoromegaly, hemihypertrophy, and an adrenal mass identified during the prenatal period. The mass was located in detected at the left suprarenal region and detected at 20 weeks of gestational age. At birth, she also presented with clitoromegaly and elevated serum levels of 17α-hydroxyprogesterone, dehydroepiandrosterone, and testosterone at birth and experienced hyper-insulinemic hypoglycemia, which improved following diazoxide therapy. We initially suspected androgen-producing ACC with metastasis and the left adrenal mass was resected accordingly when the patient reached 4 months of age. However, histological examination revealed adrenal cytomegaly. Genetic analysis revealed paternal uniparental disomy, and the patient was finally diagnosed as having BWS. Resection of the left adrenal gland restored the serum androgen levels to normal physiological levels without any recurrence. While it is reasonably well known that BWS is sometimes accompanied by virilization due to androgen-producing ACC, our findings are among the first to suggest that adrenal cytomegaly can also increase androgen hormone production. Thus, we propose that adrenal cytomegaly should be considered one of the differential diagnoses when accompanied with hyperandrogenism in BWS patients.