An interesting debate seems to have been stirred by the recent article in AJDC by Bhatia et al1 pertaining to an adrenal tumor in a child with congenital adrenal hyperplasia (CAH). The editorial in the same issue of AJDC by Lightner and Levine2 provides thoughtful insight.
Several comments are in order. First, should a child with classical CAH and an associated tumor of less than 3 cm undergo surgical removal of this tumor? Experience in adults would dictate watchful follow-up since progression to malignancy occurs only rarely.3 However, a larger issue pertains to guidelines in areas in which diagnostic and, therefore, follow-up facilities are limited.
In a vast country like India, despite tremendous development in the scientific arena, health care centers face severe limitations. Diagnostic facilities are limited owing to a shortage of trained personnel and equipment. Where facilities do exist, follow-up is severely restricted because of