Adrenal Myelolipoma: 369 Cases From a High-Volume Center

Abstract

Background: Adrenal myelolipoma (AML) is a nonfunctional benign neoplasm from the adrenal cortex, composed of mature fat and hematopoietic tissue. Usually, patients have no symptoms. However, some patients with hypertension and blood pressure normalize after AML surgery, indicating some connections between AML and hypertension.Materials and Methods: This was a retrospective cohort study of 369 patients diagnosed with AML from September 2008 to December 2018 collected in the Urology Department of West China Hospital, Chengdu, Sichuan, China. We collected clinical records of patients before surgery. Postoperative follow-up was also carried out for those with hypertension and whether patients needed to take antihypertensive drugs and postoperative blood pressure were recorded. We aim to explore the characteristics of both patients with AML having hypertension and having remission of hypertension in 1 year after surgery.Results: There were 369 patients with AML included in the study, 156 men and 213 women, aged 49.86 ± 11.61 years old. Among them, 121 (32.8%) patients presented with hypertension. Body mass index was significantly higher in the hypertension group than that in the nonhypertension group, even after adjusting other variables (26.26 ± 3.43 vs. 24.28 ± 3.38 kg/m2, P < 0.001 for both univariate and multivariate analyses). Sixty patients were followed up for 1–9 years, with a median follow-up of 52 months. The duration of hypertension in the remission group was shorter than that in the non-remission group (P = 0.020), and the tumor lateralization was significantly different between the two groups (P = 0.005).Conclusions: Nearly one-third of patients with AML suffered from hypertension in our study, and there existed some potential links between AML and hypertension. To be more specific, AML-related hypertension was more likely to result from obesity and renal compression by perirenal fat than from endocrine disorders or blood vessels compression. Patients with AML and with more than 3 years of hypertension might have less possibility to recover.

A Single-Center Experience of Special Cases: Adrenal Myelolipoma and Adrenal Adenoma with Myelolipoma Component

“…The review also found that 59.2% of the cases were on the right adrenal gland, 25.3% were on the left side, and 12.3% were reported bilaterally [4]. According to a study conducted by Lin et al, female patients were found to be dominating in 58% of a total of 369 patients diagnosed with IAM [7]. In our study, we found that the average age was 52.5 years, which is consistent with previous research.…”

Mielolipoma gigante unilateral de la glándula suprarrenal. Reporte de caso

“…Los mielolipomas de la GS fueron descritos por primera vez por Edgar Von Gierkey en 1905, y adquirieron la denominación de mielolipoma en 1929 por Charles Oberlin 6,7,8,12 . Es un tumor originado en la corteza suprarrenal, benigno, compuesto por una proporción variable de tejido adiposo maduro y hematopoyético 4,8,13 . La etiología del mielolipoma se desconoce, aunque existen varias hipótesis que incluyen: la degeneración de los tejidos epiteliales de la corteza suprarrenal, trastornos hormonales, la hematopoyesis extramedular debido a la proliferación autónoma de células de la médula ósea trans- feridas durante la embriogénesis; se plantea también relación etiopatogénica con las células madres.…”

“…Estadísticamente, la incidencia del mielolipoma suprarrenal aumenta con la edad, siendo más frecuente entre los 50 y 70 años 5,6,7,10,13 . En el 70% de los pacientes es asintomático 8,13 , afecta a ambos sexos por igual, aunque se ha descrito con mayor frecuencia en el sexo femenino 13 .…”

“…Estadísticamente, la incidencia del mielolipoma suprarrenal aumenta con la edad, siendo más frecuente entre los 50 y 70 años 5,6,7,10,13 . En el 70% de los pacientes es asintomático 8,13 , afecta a ambos sexos por igual, aunque se ha descrito con mayor frecuencia en el sexo femenino 13 . Se relaciona con la obesidad, diabetes mellitus e hipertensión arterial 5,6,10,13 , niveles altos de lípidos en sangre, enfermedad de Cushing y enfermedad de Addison 6,10 .…”

“…El mielolipoma suprarrenal tiene indicación quirúrgica cuando es sintomáticos (dolor abdominal, efecto de masa, infecciones urinarias y anemia secundaria a ruptura) y mayores a 6cm. También tiene criterio quirúrgico: si se incrementa su tamaño durante el seguimiento por su efecto de masa y el riesgo de hemorragia, por aparecer cambios en su morfología por el riesgo de malignidad 5,8,12,13 , y al tener hipertensión arterial de difícil control aunque no tenga más síntomas 6 . En los casos que el sangrado sea persistente el tratamiento quirúrgico debe ser inmediato 9,10 .…”