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Asymptomatic Testicular Adrenal Rest Tumours

The urogenital ridge is formed by a condensation of the coelomic mesoderm and gives rise to the kidney, gonads and adrenals all three organs thereby developing in close proximity. Key genes essential for urogenital ridge development include WT1 (Wilms' tumour 1) and WNT4 (winglessrelated mouse mammary tumour virus integration site). Both genes when mutated in humans have effects on adrenal development as well as the gonad and kidney. The split formation into separate renal and adrenogonadal primordia appears to depend on essential expression of SF-1 (steroidogenic factor1) and DAX-1, only in the adrenogonadal precursor tissue and not in the kidney. Thereafter, the arrival of migratory primordial germ cells from the yolk sac appears to be the cue for further differentiation of the adrenogonadal primordium into the fetal adrenal and the bipotential gonad. Following this separation of adrenal and gonadal precursors, neural crest cells migrate to the developing adrenal gland to form the medullary zone. The molecular signals which lead to separation of the adrenogonadal primordium into the fetal adrenal gland and bipotential gonad remain to be determined.