Adrenal myelolipoma: A case report and review of the literature

Abstract

A case of a 73 year old man who was preoperatively diagnosed as possibly having myelolipoma is presented herein. Adrenal myelolipoma is an uncommon benign tumor of which only 74 foreign cases and 43 Japanese cases have been previously reported in the literature dealing with surgically removed myelolipomas. The most consistent complaint of the adrenal myelolipoma sufferer is abdominal pain, caused by hemorrhaging in the tumor, and many cases are associated with obesity, hypertension and/or diabetes mellitus. There is now an increasing number of such cases being diagnosed during abdominal scanning with ultrasonography or computerized tomography for unrelated problems, whereupon the myelolipoma is usually surgically resected. With the availability of modern scanning techniques and fine needle biopsy, however, it should be possible to adopt a more conservative approach to the management of asymptomatic adrenal myelolipoma. Nevertheless, symptomatic or large tumors, must be removed since there is a high risk of spontaneous hemorrhage.

Combined Adrenal Myelolipoma and Medullary Hyperplasia

“…These large symptomatic tumors must be removed since there is a high risk of spontaneous hemorrhage. Patients harboring myelolipomas are often hypertensive, obese or diabetic [4, 8]. Although adrenal myelolipoma is a non-functioning tumor, it has occasionally been described in association with Conn’s syndrome [9, 10], Cushing’s syndrome [11, 12, 13], 21-hydroxylase deficiency [5, 14]and 17-hydroxylase deficiency [15, 16].…”

“…Occasionally, they reach massive proportions and become symptomatic [3]. Most of them are discovered incidentally during imaging procedures for unrelated problems [4]. The vast majority of cases are not associated with any specific endocrine dysfunction, but rather with obesity, hypertension, diabetes mellitus, chronic infections and illnesses [5].…”

Obstáculos diagnósticos e desafios terapêuticos no paciente obeso

“…Outra patologia de ocorrência bastante rara, porém associada na maioria dos casos com obesidade, é o mielolipoma adrenal, um tumor benigno com alto risco de hemorragia espontânea, quando, em geral, torna-se sintomático (dor abdominal) (148,149). Grandes lipomas podem levar à palpação de massas abdominais, algumas vezes fixas, que podem aderir e deslocar estruturas levando à cirurgia por vezes desnecessária e a quadros clínicos variáveis de acordo com a localização (Figura 5).…”