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PubMed This is a summary of 58 peer-reviewed journal articles Updated
Endocrinology · Adrenal Rest Tumors

Adrenal Rest Tumors (TART & OART): A Patient Guide

At a Glance

Adrenal rest tumors are noncancerous growths linked to congenital adrenal hyperplasia: TART occurs in the testes and OART in the ovaries. Once confirmed, prescribed steroid medicine and appropriate imaging can control growth and help protect fertility.

Adrenal rest tumors are a known complication of living with Congenital Adrenal Hyperplasia (CAH). These growths—known as Testicular Adrenal Rest Tumors (TART) in males and Ovarian Adrenal Rest Tumors (OART) in females—are benign (non-cancerous) once confirmed, meaning they do not spread to other parts of the body [1][2].

It is important to understand that while TARTs are relatively common in males with classic CAH (especially after puberty), OARTs are exceptionally rare in females, and their true prevalence is still uncertain [2][3].

These tumors are thought to arise from embryonic adrenal-like cells that were deposited in the reproductive organs during fetal development [4]. In people with CAH, these cells remain sensitive to ACTH (Adrenocorticotropic Hormone), a messenger from the brain that tells the adrenal glands to work. When ACTH levels remain high, these cells receive a constant signal to grow, eventually forming a mass [5].

While the word “tumor” can be frightening, the primary concern with these specific growths is not malignancy, but the “mechanical” pressure they can exert on surrounding tissue. In males, TARTs can grow large enough to compress the tubes that carry sperm, which may impact long-term fertility if left unmanaged [2][6]. Because they are not cancerous, the focus of medical care is on managing their size and protecting your reproductive health through consistent monitoring and hormone balance.

Key Takeaways for Patients

  1. Avoiding Misdiagnosis: Because a new testicular mass can also be testicular cancer, it is vital that radiologists and urologists are aware of your CAH diagnosis. A characteristic bilateral pattern on ultrasound supports a TART diagnosis and can prevent an unnecessary orchiectomy (testicle removal) [1][7]. However, an atypical, unilateral, or rapidly growing mass still requires expert evaluation to definitively rule out cancer.
  2. Proactive Monitoring: Routine screenings—primarily through scrotal ultrasound for males—allow your care team to track any changes early [8][9]. For females, routine imaging just to screen for OART is generally not recommended unless there are specific symptoms like severe persistent virilization or infertility [10].
  3. Medical Management First: The primary treatment for these tumors is medical, not surgical. By optimizing your daily glucocorticoid medications with your endocrinologist, you can lower ACTH levels, which often helps the tumors stabilize or shrink [11][12]. Never adjust your steroid dose on your own.
  4. Safety First: Not all pain or swelling is a TART. Sudden, severe pain requires emergency care.

Ultimately, adrenal rest tumors benefit from a “watchful” approach. By maintaining a steady, individualized balance of your medications and staying consistent with your follow-up appointments, you can protect your long-term health [6][13].

In this guide

5 chapters

01

Understanding Adrenal Rest Tumors (TART & OART)

Learn what adrenal rest tumors mean in congenital adrenal hyperplasia, including TARTs, OARTs, monitoring, treatment, fertility concerns, and ongoing care.

02

Symptoms and Diagnostic Imaging

Learn the symptoms of adrenal rest tumors, how ultrasound helps identify TARTs, when OARTs may be missed, and which warning signs need urgent evaluation.

03

Treatment Strategy: Medical vs. Surgical

Learn how CAH-related adrenal rest tumors are treated with steroid optimization or surgery, including overtreatment risks, fertility, and surgical options.

04

Fertility Preservation & Family Planning

Learn how CAH and adrenal rest tumors can affect fertility, including sperm banking, hormone treatment, genetic counseling, IVF, and safe pregnancy planning.

05

Long-Term Monitoring & Surveillance

Learn how to monitor adrenal rest tumors in CAH, including TART ultrasound timing, hormone blood tests, symptom-based OART evaluation, and scan anxiety support.

Common questions in this guide

What are TART and OART in congenital adrenal hyperplasia?
TARTs are benign, noncancerous growths of adrenal-like cells in the testes, while OARTs are similar growths in the ovaries. They are linked to congenital adrenal hyperplasia and do not spread once confirmed, but they can press on nearby reproductive tissue.
Why do adrenal rest tumors develop in people with CAH?
Some adrenal-like cells can remain in the reproductive organs from fetal development. In CAH, persistently high levels of ACTH, a hormone signal that tells adrenal tissue to work, can stimulate these cells to grow into a mass.
How are TARTs monitored or diagnosed?
Scrotal ultrasound is the main monitoring test for TARTs and can show the typical pattern of growth in both testes, which supports the diagnosis. A one-sided, unusual, or rapidly growing mass still needs expert evaluation to rule out testicular cancer. Routine imaging to screen for OART is generally not recommended unless symptoms such as persistent virilization or infertility occur.
Are adrenal rest tumors cancerous?
TARTs and OARTs are benign, noncancerous growths once the diagnosis is confirmed. However, a new testicular mass can resemble testicular cancer, so an atypical, one-sided, or rapidly growing lump requires specialist assessment.
Can TART affect fertility?
Yes. A TART can compress the tubes that carry sperm and may affect long-term fertility if it is not managed. Monitoring, endocrinologist-directed hormone treatment, and reproductive specialist input can help guide care.
How are adrenal rest tumors treated?
Treatment usually focuses first on optimizing prescribed glucocorticoid medicine to lower ACTH, the growth signal for adrenal-like cells. Tumors may stabilize or shrink when hormone control improves, so do not change your steroid dose without your endocrinologist.
When should I seek urgent care for pain or swelling?
Sudden, severe testicular pain requires emergency care because not all pain or swelling is caused by a TART. Contact your care team promptly about a new lump, ongoing swelling, or another concerning change.

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References

References (13)
  1. 1

    Case series of testicular adrenal rest tumours in boys with congenital adrenal hyperplasia: A single centre experience.

    Karen Leong SW, Wu LL

    The Medical journal of Malaysia 2019; (74(1)):92-93.

    PMID: 30846672
  2. 2

    Prepubertal Screening for Testicular Adrenal Rest Tumors in Boys with Classic Congenital Adrenal Hyperplasia: Emerging Evidence and Practical Implications.

    Ranieri A, Ferrari V, Ortolano R, et al.

    Children (Basel, Switzerland) 2026; (13(8)) doi:10.3390/children13081003.

    PMID: 42650343
  3. 3

    Ovarian Adrenal Rest Tumors Undetected by Imaging Studies and Identified at Surgery in Three Females with Congenital Adrenal Hyperplasia Unresponsive to Increased Hormone Therapy Dosage.

    Chen HD, Huang LE, Zhong ZH, et al.

    Endocrine pathology 2017; (28(2)):146-151 doi:10.1007/s12022-016-9461-4.

    PMID: 28032206
  4. 4

    Abundance of DLK1, differential expression of CYP11B1, CYP21A2 and MC2R, and lack of INSL3 distinguish testicular adrenal rest tumours from Leydig cell tumours.

    Lottrup G, Nielsen JE, Skakkebæk NE, et al.

    European journal of endocrinology 2015; (172(4)):491-9 doi:10.1530/EJE-14-0810.

    PMID: 25609776
  5. 5

    Challenges in Adolescent and Adult Males With Classic Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency.

    Claahsen-van der Grinten HL, Adriaansen BPH, Falhammar H

    The Journal of clinical endocrinology and metabolism 2025; (110(Supplement_1)):S25-S36 doi:10.1210/clinem/dgae718.

    PMID: 39836620
  6. 6

    Experience in optimizing fertility outcomes in men with congenital adrenal hyperplasia due to 21 hydroxylase deficiency.

    King TF, Lee MC, Williamson EE, Conway GS

    Clinical endocrinology 2016; (84(6)):830-6 doi:10.1111/cen.13001.

    PMID: 26666213
  7. 7

    Metachronous Bilateral Testicular Leydig-Like Tumors Leading to the Diagnosis of Congenital Adrenal Hyperplasia (Adrenogenital Syndrome).

    Vukina J, Chism DD, Sharpless JL, et al.

    Case reports in pathology 2015; (2015()):459318 doi:10.1155/2015/459318.

    PMID: 26351608
  8. 8

    MANAGEMENT OF ENDOCRINE DISEASE: Gonadal dysfunction in congenital adrenal hyperplasia.

    Claahsen-van der Grinten HL, Stikkelbroeck N, Falhammar H, Reisch N

    European journal of endocrinology 2021; (184(3)):R85-R97.

    PMID: 33320831
  9. 9

    Longitudinal Characterization and Sonographic Staging of Testicular Adrenal Rest Tumors.

    Vaid S, Kulkarni S, Marko J, et al.

    The Journal of clinical endocrinology and metabolism 2026; (111(3)):698-706 doi:10.1210/clinem/dgaf498.

    PMID: 40921717
  10. 10

    [Characterization of ovarian adrenal rest tumors in children and adolescent females with congenital adrenal hyperplasia due to 21-hydroxylase deficiency].

    Su Z, Li YY, Ma HM, et al.

    Zhonghua er ke za zhi = Chinese journal of pediatrics 2016; (54(6)):414-8 doi:10.3760/cma.j.issn.0578-1310.2016.06.005.

    PMID: 27256226
  11. 11

    Testicular adrenal rest tumors - Epidemiology, diagnosis and treatment.

    Eyer de Jesus L, Paz de Oliveira AP, Porto LC, Dekermacher S

    Journal of pediatric urology 2024; (20(1)):77-87 doi:10.1016/j.jpurol.2023.10.005.

    PMID: 37845103
  12. 12

    Testicular Adrenal Rest Tumour (TART) or Testicular Malignancy: A Clinical Dilemma.

    Roy M, Roy AK, Chatterjee T, Bansal S

    European journal of case reports in internal medicine 2020; (7(8)):001669 doi:10.12890/2020_001669.

    PMID: 32789136
  13. 13

    How to manage puberty and prevent fertility disorders in men with CAH?

    Claahsen-van der Grinten HL

    Annales d'endocrinologie 2022; (83(3)):186-187 doi:10.1016/j.ando.2022.04.005.

    PMID: 35436502

This page explains adrenal rest tumors in people with congenital adrenal hyperplasia for informational purposes only and does not constitute medical advice. Ask your endocrinologist, urologist, or other clinician how to interpret your symptoms and imaging.