{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T11:56:41Z","timestamp":1764331001143,"version":"3.37.3"},"reference-count":12,"publisher":"The Endocrine Society","issue":"12","license":[{"start":{"date-parts":[[2019,10,17]],"date-time":"2019-10-17T00:00:00Z","timestamp":1571270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000098","name":"NIH Clinical Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000098","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Testicular adrenal rest tumors (TARTs) are a common cause of male infertility in patients with classic congenital adrenal hyperplasia (CAH). These tumors are located in the rete testis and can lead to impaired blood flow and functional impairment of seminiferous tubules. We describe restoration of fertility in a man with CAH and bilateral TARTs with use of lower-dose glucocorticoid therapy than previously described. A 28-year-old man with classic salt-wasting CAH presented with impaired fertility. Biochemical evaluation showed poor CAH control despite reported compliance with prednisone 5 mg every morning and fludrocortisone 50 \u03bcg twice daily. Semen analysis showed azoospermia. Testicular ultrasonography showed TARTs occupying 16% of total testicular volume. After 5 months of dexamethasone 250 \u03bcg at bedtime, total TART volume decreased 90%, biochemical control improved, and semen analysis showed a sperm count of 132 \u00d7 106 million per milliliter. The patient\u2019s wife was confirmed to be pregnant 9 months after the initial visit and delivered a healthy full-term baby girl. The patient\u2019s glucocorticoid therapy was changed to prednisone 3 mg twice daily, and 2 years later he continues to show adequate CAH control, stable TART volume, and normal semen analysis, and his wife is pregnant again. Management of CAH in men with TARTs needs to be individualized, and high-dose dexamethasone may not be indicated. The use of a long-acting glucocorticoid at typical recommended dosages can decrease TART size and reverse male infertility. Prednisone given once daily does not adequately control the ACTH-driven complications of CAH.<\/jats:p>","DOI":"10.1210\/js.2019-00227","type":"journal-article","created":{"date-parts":[[2019,10,17]],"date-time":"2019-10-17T09:09:04Z","timestamp":1571303344000},"page":"2290-2294","source":"Crossref","is-referenced-by-count":15,"title":["Individualizing Management of Infertility in Classic Congenital Adrenal Hyperplasia and Testicular Adrenal Rest Tumors"],"prefix":"10.1210","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9201-3340","authenticated-orcid":false,"given":"Smita","family":"Jha","sequence":"first","affiliation":[{"name":"Section on Congenital Disorders, National Institutes of Health Clinical Center, Bethesda, Maryland"},{"name":"Clinical and Investigative Orthopedics Surgery Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diala","family":"El-Maouche","sequence":"additional","affiliation":[{"name":"Section on Congenital Disorders, National Institutes of Health Clinical Center, Bethesda, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie","family":"Marko","sequence":"additional","affiliation":[{"name":"Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashwini","family":"Mallappa","sequence":"additional","affiliation":[{"name":"Section on Congenital Disorders, National Institutes of Health Clinical Center, Bethesda, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Padmasree","family":"Veeraraghavan","sequence":"additional","affiliation":[{"name":"Section on Congenital Disorders, National Institutes of Health Clinical Center, Bethesda, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah P","family":"Merke","sequence":"additional","affiliation":[{"name":"Section on Congenital Disorders, National Institutes of Health Clinical Center, Bethesda, Maryland"},{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","published-online":{"date-parts":[[2019,10,17]]},"reference":[{"issue":"5","key":"2019111315193510200_bib1","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1210\/jc.2008-1414","article-title":"High prevalence of reduced fecundity in men with congenital adrenal hyperplasia","volume":"94","author":"Reisch","year":"2009","journal-title":"J Clin Endocrinol Metab"},{"issue":"3","key":"2019111315193510200_bib2","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1093\/humupd\/dmp048","article-title":"World Health Organization reference values for human 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