Giant secreting adrenal myelolipoma in a man: a case report

Abstract

IntroductionAdrenal myelolipoma is a rare, benign neoplasm that is usually asymptomatic, unilateral and nonsecreting. It develops within the adrenal gland and is composed of mature adipose tissue with elements of the hematopoietic series. We describe the case of what is, to the best of our knowledge, one of the largest secreting adrenal myelolipomas reported in the literature.Case presentationA 52-year-old Caucasian man of medium build who had had moderate hypertension for three years presented to our hospital. He had no other significant symptoms. His hypertension was pharmacologically treated. He came to our hospital to undergo abdominal ultrasonography during a clinical checkup. The ultrasound scan showed the presence of a voluminous hyperechoic mass interposed between the spleen and the left kidney. It was reported as a myelolipoma of the left kidney on the basis of its structural characteristics and position. Computed tomography confirmed our diagnosis. All preoperative biochemical tests were normal, with the exception of high serum cortisol, which was being overproduced by the lesion and was probably responsible for the patient's hypertension. He underwent successful surgery, and his postoperative course was uneventful. The pathologic examination of the lesion confirmed the diagnosis of adrenal myelolipoma. The patient's blood pressure returned to within the normal range.ConclusionsThe "incidental" discovery of an adrenal mass requires careful diagnostic study to plan adequate therapeutic management. Both of the primary investigations at our disposal, ultrasound and blood tests (adrenal hormones), helped in rendering the diagnosis and allowed us to move toward the most appropriate treatment, taking into account the size of the tumor and its probable hormonal production.

Adrenal Myelolipoma Diagnosed in a 72-Year-Old Patient with Abdominal Pain

“…The largest tumor ever recorded was 31 x 24.5 x 11.5 cm and weighed 6 kg [9]. In cases of tumors smaller than 4 cm, conservative management is the choice, and surgery is indicated for cases larger than this value.…”

Multicentric Adrenal Myelolipomas: Case Report

“…They are non-functional tumors composed of mature adipocytes and active hematopoietic ele- Asil et al J Med Cases. 2015;6(2):91-94 ments and take origin from the adrenal cortex [2,3]. Although there are a few theories on AL histogenesis, it is still uncertain [3].…”

“…2015;6(2):91-94 ments and take origin from the adrenal cortex [2,3]. Although there are a few theories on AL histogenesis, it is still uncertain [3]. The most accepted theory is metaplasia of reticuloendothelial cells of blood capillaries in the adrenal gland in response to stimuli such as chronic infection, stress or necrosis [2].…”

“…Even though adrenal myelolipomas are usually associated with obesity, hypertension and diabetes mellitus, generally are asymptomatic and discovered incidentally at autopsy or by radiologic imaging [2]. Lesions are usually unilateral, but it has been rarely reported on both sides in the literature [3,4]. In this report we present the case with two myelolipomas at the right adrenal gland that was undefined in the literature.…”

Giant Bilateral Adrenal Myelolipoma with Congenital Adrenal Hyperplasia

“…More severe symptoms include hematuria, renovascular hypertension, and even surgical emergencies such as retroperitoneal hemorrhage [6, 11]. Therefore, it is important to realize the significance of incidental findings and management should be geared towards preventing such severe consequences.…”