Clinical course of adrenal myelolipoma: A long‐term longitudinal follow‐up study

Abstract

Objective We aimed to describe clinical course of myelolipoma and to identify predictors of tumour growth and need for surgery. Design A retrospective study. Patients Consecutive patients with myelolipoma. Results A total of 321 myelolipomas (median size, 2.3 cm) were diagnosed in 305 patients at median age of 63 years (range, 25‐87). Median follow‐up was 54 months. Most myelolipomas were incidentally detected (86%), whereas 9% were discovered during cancer staging and 5% during workup of mass effect symptoms. Thirty‐seven (12%) patients underwent adrenalectomy. Compared to myelolipomas <6 cm, tumours ≥6 cm were more likely to be bilateral (21% vs 3%, P < .0001), cause mass effect symptoms (32% vs 0%, P < .0001), have haemorrhagic changes (14% vs 1%, P < .0001) and undergo adrenalectomy (52% vs 5%, P < .0001). Among patients with ≥6 months of imaging follow‐up, median size change was 0 mm (−10, 115) and median growth rate was 0 mm/y (−6, 14). Compared to <1 cm growth, ≥1 cm growth correlated with larger initial size (3.6 vs 2.3 cm, P = .02), haemorrhagic changes (12% vs 2%, P = .007) and adrenalectomy (35% vs 8%, P < .0001). Conclusions Most myelolipomas are incidentally discovered on cross‐sectional imaging. Myelolipomas ≥6 are more likely to cause mass effect symptoms, have haemorrhagic changes and undergo resection. Tumour growth ≥1 cm is associated with larger myelolipoma and haemorrhagic changes. Adrenalectomy should be considered in symptomatic patients with large tumours and when there is evidence of haemorrhage or tumour growth.

A Rare Case of Hemorrhagic Giant Adrenal Myelolipoma: Radiographic and Pathologic Correlation

“…Most of these tumors are < 4 cm when first discovered and many either do not grow or demonstrate slow growth [ 7 ]. One study looking at 320 myelolipomas found that the median tumor size minimally increased from 2.3 to 2.6 cm and only 16% of myelolipomas grew more than 1 cm over four and a half years of follow-up [ 4 ]. The pathogenesis of these tumors remains unclear.…”

“…Myelolipomas are usually asymptomatic, however patients may feel pain if they are large or have hemorrhage [ 1 ]. Hemorrhagic myelolipomas are a rare entity with spontaneous tumor ruptures occurring in only 4.5% of tumors [ 4 ]. These bleeds can cause retroperitoneal, intraperitoneal, or intralesional bleeding and most tend to occur in lesions greater than 10 cm [ 5 , 6 ].…”

Development of a large adrenal myelolipoma in the context of long-term elevated ACTH

“…There are no guidelines for treatment but for large, rapidly growing tumours and those with compressive symptoms, surgery is considered. Up to 86% of myelolipomas are detected incidentally on imaging, 1 and the incidence is expected to rise with the increased use of abdominal imaging in clinical practice.…”

“…The aetiology of myelolipomas is not established, but the increased incidence in patients with CAH and Cushing's disease, both of whom have raised ACTH levels, has suggested a role for prolonged ACTH stimulation. 1 The role of hormones in inducing adrenal tumours was first proposed by Selye and Stone in 1950 who was able to induce bone marrow tissue like changes by injecting anterior pituitary hormone extracts into normal rat adrenal glands. 2 The increased expression of Melanocortin two receptor (MC2R) on adrenal myelolipomas further supports the role of ACTH.…”

Giant symptomatic adrenal myelolipoma: A case report

“…Adrenal myelolipomas (AMLs) are rare non-functioning benign tumors composed of adipose and hematopoietic tissues [ 1 ]. AMLs are found in one out of 500–1250 autopsy cases [ 2 ].…”