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Brutvan T, Psenicka O, Krizova J, Kotasova M, Jezkova J. Giant Bilateral Adrenal Myelolipomas in a Non-Compliant Patient with Congenital Adrenal Hyperplasia. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943005. [PMID: 38582958 PMCID: PMC11009887 DOI: 10.12659/ajcr.943005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/21/2024] [Accepted: 02/16/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND 21-hydroxylase deficiency, an essential enzyme for glucocorticoid and mineralocorticoid synthesis, is the cause of congenital adrenal hyperplasia (CAH) in more than 95% of cases. It is an autosomal recessive disorder encoded by the CYP21A2 gene, categorized into classical forms, which encompass the salt-wasting (SW) and simple virilizing (SV) forms, as well as the nonclassical form (NC). The aim of medical treatment is to replace missing glucocorticoids and, if necessary, mineralocorticoids, while also reducing elevated adrenal androgens. CASE REPORT We present the case of a 42-year-old woman with CAH who discontinued therapy during adolescence and was admitted to hospital with fatigue, nausea, and severe abdominal pain. A CT scan showed an extreme enlargement of the adrenal glands. Laboratory tests revealed elevated levels of 17-hydroxyprogesterone and other adrenal androgens, along with normal plasma metanephrine levels. Decreased morning cortisol levels suggested partial adrenal insufficiency requiring glucocorticoid replacement therapy. Due to the development of several serious complications and clinical deterioration, the multidisciplinary team recommended bilateral removal of masses measuring 300×250×200 mm on the right side and 250×200×200 mm on the left side. Histological and immunochemical examination confirmed the presence of giant myelolipomas with adrenal cortex hyperplasia. CONCLUSIONS Adrenal tumors, particularly myelolipomas, have a higher prevalence in patients with CAH. Our case report provides further evidence of the suspected link between non-compliant CAH therapy and the development of myelolipomas, along with promotion of their pronounced growth.
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Affiliation(s)
- Tomas Brutvan
- 3 Department of Internal Medicine, General University Hospital in Prague and the 1 Faculty of Medicine of the Charles University, Prague, Czech Republic
| | - Otakar Psenicka
- 3 Department of Internal Medicine, General University Hospital in Prague and the 1 Faculty of Medicine of the Charles University, Prague, Czech Republic
| | - Jarmila Krizova
- 3 Department of Internal Medicine, General University Hospital in Prague and the 1 Faculty of Medicine of the Charles University, Prague, Czech Republic
| | - Marcela Kotasova
- Institute of Clinical Biochemistry and Laboratory Medicine, General University Hospital in Prague and the 1 Faculty of Medicine of the Charles University, Prague, Czech Republic
| | - Jana Jezkova
- 3 Department of Internal Medicine, General University Hospital in Prague and the 1 Faculty of Medicine of the Charles University, Prague, Czech Republic
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M M Zeer Z, Noman M, Alzeer AM, Mahamid Y, Abu Moch M, Atwaneh A. Bilateral Adrenal Myelolipoma and Breast Cancer in a Patient With Congenital Adrenal Hyperplasia. Cureus 2024; 16:e54784. [PMID: 38529452 PMCID: PMC10961256 DOI: 10.7759/cureus.54784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 03/27/2024] Open
Abstract
Adrenal myelolipoma is a rare, benign tumor of the adrenal gland, typically non-functional, asymptomatic and unilateral. With the increased use of radiological imaging, it has been discovered more frequently as incidental mass. It is common to occur concurrently with hormonal dysfunction conditions like congenital adrenal hyperplasia. However, there are few previous reported cases of malignancy concomitant with adrenal myelolipoma. We present a case of a 33-year-old patient diagnosed with congenital adrenal hyperplasia since birth. She was diagnosed with giant bilateral adrenal myelolipoma incidentally during the investigation done for staging her breast cancer. To the best of our knowledge, this is the second reported case of breast cancer concomitant with adrenal myelolipoma. Although this entity is very rare, physicians should be familiar with such rare adrenal masses and their associations in order to manage them appropriately.
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Affiliation(s)
| | - Mahmoud Noman
- Faculty of Medicine, Al-Quds University, Jerusalem, PSE
| | | | | | | | - Alaa Atwaneh
- Endocrinology, Augusta Victoria Hospital, Jerusalem, PSE
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Feng Q, Li H, Chen X, Feng X, Li J. Case report: Adrenal myelolipoma resected by laparoscopic surgery. Front Oncol 2022; 12:1058211. [PMID: 36544699 PMCID: PMC9760819 DOI: 10.3389/fonc.2022.1058211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/16/2022] [Indexed: 12/08/2022] Open
Abstract
Introduction Adrenal myelolipomas are benign tumors composed mainly of lipomatous elements with myeloid cells. With the development of medical imaging technology, the detection rate has gradually increased. We report a case of adrenal myelolipoma successfully excised through the laparoscope and reviewed existing literature in recent ten years to summarize the feasibility of the laparoscopic approach for this tumor. Case presentation Herein, we described a case of adrenal myelolipoma resected by laparoscope in a 63-year-old male patient. He did not have any other symptoms except the incidental finding of a left adrenal mass. An abdominal CT examination revealed a mixed-density lesion containing some amount of adipose tissue. In conjunction with the patient's willingness, we performed a laparoscopic operation to remove the lump. The definite diagnosis was confirmed as an adrenal myelolipoma according to the pathology. The patient recovered well postoperatively and without signs of recurrence at a 5-month follow-up. Conclusion Adrenal myelolipoma is commonly benign, asymptomatic, and hormonal inactivity. A surgical strategy is suggested for high-complication-risk patients. The laparoscopic approach is safe and effective with an obvious advantage over open procedures.
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Affiliation(s)
- Qingbo Feng
- Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hancong Li
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinyang Chen
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuping Feng
- Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiaxin Li
- Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China,Department of General Surgery, Dafang County People’s Hospital, Bijie, Guizhou, China,*Correspondence: Jiaxin Li,
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Laparoscopic adrenalectomy for a giant adrenal myelolipoma: A case report. Int J Surg Case Rep 2021; 90:106678. [PMID: 34952312 PMCID: PMC8715075 DOI: 10.1016/j.ijscr.2021.106678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 12/14/2022] Open
Abstract
CASE PRESENTATION We describe a case of a patient who presented with a mildly symptomatic, giant myelolipoma which was excised by laparoscopic approach without complications. INTRODUCTION AND IMPORTANCE Adrenal myelolipoma (AML) is a rare tumour composed by fat and myeloid tissues. Usually it is asymptomatic, so the diagnosis is mostly incidental. It is generally located in the right adrenal gland, but it can also be found bilaterally. If its size exceeds 10 cm it is defined as a "giant myelolipoma"; in this case its treatment of choice would be adrenalectomy with an open surgical approach. CLINICAL DISCUSSION Patient's signs and symptoms were mild pain in the right hypochondrium and a positive right Giordano's sign. The mass was detected by a contrast-enhanced CT scan. Once excised it measured 16 cm. CONCLUSION Laparoscopic adrenalectomy for giant myelolipoma is a safe approach if performed by an expert surgeon, with low risk of bleeding and a better outcome for the patient.
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Gadelkareem RA, Moeen AM, Khalil M, Reda A, Farouk M, Abdelkawi IF, Makboul R, Mohammed N, Hameed DA. Experience of a Tertiary-Level Urology Center in Clinical Urological Events of Rare and Very Rare Incidence. V. Urological Tumors: 1. Adrenal Myelolipoma. Curr Urol 2020; 14:85-91. [PMID: 32774233 PMCID: PMC7390982 DOI: 10.1159/000499254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 03/26/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To present our center's experience in the management of adrenal myelolipoma in the context of shifting from the open to the laparoscopic adrenalectomy approach. MATERIALS AND METHODS A retrospective search of our center's records was done for reported cases of adrenal myelolipoma during the period July 2001-June 2016. All the cases with histopathologically-documented adrenal myelolipoma diagnosis were included. Relevant demographic and clinical variables were studied with a comparison between the open and laparoscopic approaches. RESULTS Of more than 82,000 urological surgeries, 238 adrenalectomies were done with only 22 cases of myelolipoma that had a mean age and body mass index of 52.4 ± 10.3 years and 30.23 kg/m2, respectively. The main clinical presentation was accidental discovery. The largest dimension of tumors varied from 6 to 16 cm. Computed tomography described a characteristic picture of hypodense heterogeneous adrenal tumors in all cases, while magnetic resonance imaging was indicated for malignancy suspicion in only 5 cases. Adrenal tumor markers were normal in all cases. Open and transperitoneal laparoscopic adrenalectomies were used in 14 and 8 cases, respectively. The latter approach was insignificantly advantageous in the need for blood transfusion, postoperative pain degree, need for analgesia, and hospital stay duration (p = 0.22). Histo-pathological examination revealed benign adipose tissue and myeloid cells and confirmed the diagnosis of adrenal myelolipoma in all cases. CONCLUSIONS Adrenal myelolipoma is a rare non-functioning benign tumor. Laparoscopic excision seems to be a promising alternative approach to the traditional open adrenalectomy, even in the context of large tumors and obesity.
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Affiliation(s)
- Rabea A. Gadelkareem
- Assiut Urology and Nephrology Hospital, Faculty of Medicine
- *Rabea Ahmed Gadelkareem, Elgamaa Street, Faculty of Medicine, Assiut University, EG-71515 Assiut (Egypt), E-Mail
| | - Ahmed M. Moeen
- Assiut Urology and Nephrology Hospital, Faculty of Medicine
| | - Mahmoud Khalil
- Assiut Urology and Nephrology Hospital, Faculty of Medicine
| | - Ahmed Reda
- Assiut Urology and Nephrology Hospital, Faculty of Medicine
| | - Mahmoud Farouk
- Assiut Urology and Nephrology Hospital, Faculty of Medicine
| | | | - Rania Makboul
- Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nasreldin Mohammed
- Assiut Urology and Nephrology Hospital, Faculty of Medicine
- Department of Urology, Martin-Luther University, Halle, Germany
| | - Dia A. Hameed
- Assiut Urology and Nephrology Hospital, Faculty of Medicine
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Vigutto G, Lauro A, Vaccari S, Pirini MG, Diegoli M, D'Andrea V, Marino IR, Cervellera M, Tonini V. Giant Retroperitoneal Myelolipoma: An Unusual Diagnostic GI Challenge-Case Report and Review of the Literature. Dig Dis Sci 2019; 64:3431-3435. [PMID: 31620928 DOI: 10.1007/s10620-019-05897-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Myelolipomas are rare, benign neoplasms usually arising from the retroperitoneum. They represent an unusual diagnostic challenge due to their vague GI symptoms. We present a case of an 81-year-old patient complaining of severe dyspepsia. An abdominal CT scan and a fine needle biopsy lead to a diagnosis of giant retroperitoneal myelolipoma. A complete surgical resection was performed; no evidence of recurrent tumor was noted after 10 months. AREAS COVERED Giant myelolipomas are very rare lesions. Clinical diagnosis of myelolipomas can be problematic due to their indefinite symptoms. CT scan and fine needle biopsy can be useful to reach a diagnosis, although they cannot be used to exclude malignancy in giant lesions. Surgery is the principal treatment if the tumor is symptomatic or > 7 cm. Follow-up is not mandatory due to the lack of any example of recurrence described in literature. EXPERT COMMENTARY Despite the size of the neoplasms, since most of the complaints are vague, patients with this diagnosis should be considered among patients with unexplained gastrointestinal symptoms. Since malignancy cannot be excluded based on preoperative and intraoperative biopsy, an aggressive surgical approach is essential.
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Affiliation(s)
- G Vigutto
- Surgery Emergency Department, St. Orsola University Hospital, Bologna, Italy
| | - A Lauro
- Surgery Emergency Department, St. Orsola University Hospital, Bologna, Italy.
| | - S Vaccari
- Surgery Emergency Department, St. Orsola University Hospital, Bologna, Italy
| | - M G Pirini
- Pathological Anatomy Department, St. Orsola University Hospital, Bologna, Italy
| | - M Diegoli
- Preventive and Diagnostic Medicine Department, St. Orsola University Hospital, Bologna, Italy
| | - V D'Andrea
- Department of Surgical Sciences, Umberto I Hospital, La Sapienza University, Rome, Italy
| | - I R Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Cervellera
- Surgery Emergency Department, St. Orsola University Hospital, Bologna, Italy
| | - V Tonini
- Surgery Emergency Department, St. Orsola University Hospital, Bologna, Italy
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Cochetti G, Paladini A, Boni A, Silvi E, Tiezzi A, De Vermandois JAR, Mearini E. Robotic treatment of giant adrenal myelolipoma: A case report and review of the literature. Mol Clin Oncol 2019; 10:492-496. [PMID: 31007910 PMCID: PMC6467000 DOI: 10.3892/mco.2019.1823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 02/13/2019] [Indexed: 02/07/2023] Open
Abstract
Adrenal myelolipoma is a rare mesenchymal tumour with benign biological behaviour that is mainly composed of mature adipose and myeloid tissue. Both sexes are equally affected, most commonly between the fifth and seventh decades of life. The diagnosis of adrenal myelolipoma is mostly incidental. Although it may occasionally be associated with necrosis, rupture and haemorrhage, causing abdominal pain, this tumour is usually asymptomatic. Consequently, management is conservative, while surgical treatment is reserved for symptomatic cases, or for masses growing quickly or to a size >6 cm. Giant myelolipomas (sized >10 cm) are rare. Open radical adrenalectomy is the standard treatment for giant myelolipomas, while the minimally invasive approach has been used in only few cases. We herein report the case of a patient with a giant adrenal myelolipoma who underwent robotic partial adrenalectomy. To the best of our knowledge, this is the largest giant adrenal myelolipoma treated with robotic surgery reported in the literature to date. A 55-year-old male patient underwent an abdominal computed tomography scan during follow-up after radical prostatectomy for prostate cancer Gleason Score 6 (ISUP 1) due to biochemical recurrence. The examination revealed a right hypodense adrenal mass, sized 16×13 cm. Abdominal magnetic resonance imaging confirmed the presence of characteristics suggestive of a myelolipoma. The patient did not report any symptoms. Due to the benign characteristics of the mass, robotic partial adrenalectomy and enucleation of the mass were performed. The operative time and estimated blood loss were 205 min and 100 ml, respectively. No intra- or postoperative complications occurred. The patient was mobilized on the first postoperative day and the time to flatus was 36 h; the length of hospitalization was 4 days. Histological examination confirmed the diagnosis of adrenal myelolipoma, sized 18×11.5×6 cm. No tumour recurrence occurred over a follow-up period of 12 months. In conclusion, robotic surgery allows performing partial adrenalectomy with a lower risk of bleeding and with preservation of healthy adrenal tissue, which is of paramount importance for the patient as it reduces recovery time and the need for medical substitution therapy.
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Affiliation(s)
- Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
| | - Alessio Paladini
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
| | - Andrea Boni
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
| | - Elisa Silvi
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
| | - Alberto Tiezzi
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
| | - Jacopo Adolfo Rossi De Vermandois
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Inter-Divisional Urology Clinic (Perugia-Terni), Santa Maria della Misericordia University Hospital, I-06156 Perugia, Italy
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8
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Affiliation(s)
| | - Yizhak Kupfer
- Department of Pulmonary and Critical Care Medicine, Maimonides Medical Center, New York, USA
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9
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Giant Adrenal Myelolipoma in a Patient without Endocrine Disorder: A Case Report and a Review of the Literature. Case Rep Surg 2018; 2018:4854368. [PMID: 29992078 PMCID: PMC6016169 DOI: 10.1155/2018/4854368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/23/2018] [Indexed: 12/24/2022] Open
Abstract
We herein present a surgically treated case of huge adrenal myelolipoma. A 62-year-old woman presented to our surgical outpatient clinic with a retroperitoneal tumor. A clinical examination revealed an elastic soft, smooth-surfaced, painless, child-head-sized tumor with poor mobility, which was located in the left upper abdomen. Computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen revealed an uneven tumor surrounding the stomach, spleen, pancreas, and left kidney, which was 20 × 18 × 10 cm in size. The retroperitoneal tumor was resected. The tumor was attached to the surrounding organs, including the pancreas, spleen, and left kidney, but had not directly invaded these organs. The tumor was yellow and elastic soft and covered with a thin film. The origin of the tumor was suggested to be the left adrenal gland. The weight of the excised tumor was 1500 g. The histopathological diagnosis was adrenal myelolipoma. The patient had an uneventful recovery and was discharged from the hospital on the thirteenth day after the operation. She has been followed up in our outpatient clinic.
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10
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D'Addosio R, Rojas J, Bermúdez V, Ledesma F, Hoedebecke K. Case Report: An incidentaloma that catches your eye - adrenal myelolipoma. F1000Res 2017; 6:1140. [PMID: 28794862 PMCID: PMC5538031 DOI: 10.12688/f1000research.11766.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 01/19/2023] Open
Abstract
Background: Adrenal incidentaloma refers to the incidental finding of a tumor in the adrenal gland, where nonfunctional forms are the most common variant. Myelolipoma is a rare (0.08-0.4%) occurrence characterized by adipose and hematopoietic tissue. The aim of this case report is to describe the diagnosis and appropriate management of a myelolipoma in an asymptomatic patient, which was originally considered an incidental hepatic hemangioma prior to being identified as a giant adrenal adenoma. Case description: The patient was a 54 year old obese female with a recent diagnosis of diabetes type II and dyslipidemia with recent ultrasound imaging suggestive of a hepatic hemangioma. An MRI was performed revealing a 7x6cm lesion in the right adrenal area indicating a giant adrenal adenoma. An adrenalectomy was performed without complications. The pathology report identified a myelolipoma. Discussion: The incidence of myelolipoma has recently increased due to advances in radiological techniques. Its etiology is unclear and the most accepted theories support a myeloid cell metaplasia in the embryonic stage as a result of stress, infections, or adrenocorticotropic hormone or erythropoietin stimulus. Contributing components may include bone morphogenetic protein 2 and β-catenin, as well as the presence of the chromosomal translocation (3, 21) (q25; p11). Despite its benign nature, the association with other adrenal lipomas must be ruled out. A biochemical evaluation is essential for detecting subclinical states, such as Cushing syndrome and pheochromocytoma. Conclusion: Adrenal myelolipomas are rare benign tumors that are generally asymptomatic. Uncertainty still exists surrounding their etiology. Surgical management depends on hormone production, tumor size, high risk features on imaging and patient consent. Additional information is needed to better understand myelolipomas, their etiology, and clinical management. Incidentalomas may confuse the physician and patient. Ensuring proper multidisciplinary management based on the clinical guidelines of endocrinology allowed a satisfactory resolution of this case.
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Affiliation(s)
- Rosanna D'Addosio
- Department of Public Health, School of Medicine, University of Zulia, Maracaibo, 4002, Venezuela
| | - Joselyn Rojas
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.,Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, 4002, Venezuela
| | - Valmore Bermúdez
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, 4002, Venezuela.,Research group Altos Estudios de Frontera (ALEF), The Simón Bolívar University, Cúcuta, Colombia
| | - Flor Ledesma
- Department of Public Health, School of Medicine, University of Zulia, Maracaibo, 4002, Venezuela
| | - Kyle Hoedebecke
- WONCA Polaris - USA, Bangkok, 10500, Thailand.,Yongsan Health Clinic, Seoul, 96205, Korea, South
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Chakraborty PP, Bhattacharjee R, Mukhopadhyay P, Chowdhury S. Bilateral adrenal myelolipoma in Cushing's disease: a relook into the role of corticotropin in adrenal tumourigenesis. BMJ Case Rep 2016; 2016:bcr-2016-214965. [PMID: 27307426 DOI: 10.1136/bcr-2016-214965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Adrenal myelolipomas are infrequently encountered benign tumours of unknown aetiology. In the majority of cases they are unilateral, and clinically and hormonally silent, only requiring periodic follow-up. However, bilateral adrenal myelolipomas are sometimes associated with endocrine disorders and warrant appropriate evaluation. Though the understanding of the pathophysiology of adrenal myelolipomas has long been elusive, adrenocorticotropic hormone (ACTH) has been proposed as the main tropic factor in a number of studies. Cushing's disease is rarely associated with bilateral and sometimes giant myelolipomas. In this article, the association of bilateral adrenal myelolipomas with Cushing's disease has been discussed and the role of ACTH in the tumourigenesis has been reviewed.
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Affiliation(s)
| | - Rana Bhattacharjee
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, West Bengal, India
| | - Pradip Mukhopadhyay
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology & Metabolism, IPGME&R/SSKM Hospital, Kolkata, West Bengal, India
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12
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Kale G, Pelley EM, Davis DB. Giant myelolipomas and inadvertent bilateral adrenalectomy in classic congenital adrenal hyperplasia. Endocrinol Diabetes Metab Case Rep 2015; 2015:150079. [PMID: 26527321 PMCID: PMC4626646 DOI: 10.1530/edm-15-0079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 08/28/2015] [Indexed: 11/08/2022] Open
Abstract
UNLABELLED Myelolipomas have been reported in patients with congenital adrenal hyperplasia (CAH). ACTH excess, as seen with non-adherence to glucocorticoid therapy, may be responsible for tumor development. We report a case of a 51-year-old man with classic salt-wasting CAH managed on prednisone 7.5 mg daily and fludrocortisone who presented with chronic back pain and was found to have giant bilateral retroperitoneal masses. On computed tomography (CT) imaging, the masses were heterogeneous, but contained predominantly low-density fat attenuation. The tumors were resected due to concern for malignancy and mass symptoms. Pathologic examination identified both retroperitoneal masses as myelolipomas. The left tumor was 34×20×13 cm and weighed 4.7 kg and the right tumor was 20 cm in the largest dimension. Adrenal tissue was present in the specimen. The patient reported long-term compliance with glucocorticoid treatment. However, no biochemical monitoring of ACTH levels had occurred. Therefore, it is unclear if ACTH excess contributed to the development of these large tumors in this patient. It was presumed that both adrenal glands were inadvertently removed during surgery and the patient was treated with physiologic replacement doses of hydrocortisone and fludrocortisone postoperatively. In this case, the bilateral adrenalectomy was inadvertent. However, adrenalectomy can be considered as a treatment option in patients with classical CAH under certain circumstances to avoid complications of glucocorticoid excess. LEARNING POINTS Myelolipomas should be considered in the differential diagnosis of adrenal or retroperitoneal masses in patients with CAH.On CT imaging, myelolipomas are seen as heterogeneous masses with low-density mature fat interspersed with more dense myeloid tissue.Myelolipomas are usually unilateral and measure <4 cm; however, very large and bilateral tumors have been reported.Treatment of CAH typically involves using supraphysiologic doses of glucocorticoid to suppress adrenal hyperandrogenism. Bilateral adrenalectomy is an alternative treatment option in patients with CAH.There is an association between ACTH excess and increased incidence of adrenal myelolipoma but the direct causal link remains to be established.
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Affiliation(s)
- Geetanjali Kale
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Wisconsin , Madison, Wisconsin , USA
| | - Elaine M Pelley
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Wisconsin , Madison, Wisconsin , USA
| | - Dawn Belt Davis
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Wisconsin , Madison, Wisconsin , USA
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