Giant Adrenal Myelolipoma

Alvarez, Juan F.; Goldstein, Lindsey; Samreen, Naziya; Beegle, Richard D.; Carter, Christopher; Shaw, Christiana; Ben-David, Kfır

doi:10.1007/s11605-014-2553-x

Cited by 13 publications

(17 citation statements)

References 8 publications

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“…Calcifications are seen in 27% of myelolipomas (10). Hemorrhage within the tumor might increase the tissue density and HU, as was seen in this case (1,2). Pheochromocytoma precontrast attenuation values are generally >10 HU (11).…”

Section: Discussionmentioning

confidence: 55%

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Hypertensive Emergency Following Embolization of a Large Adrenal Myelolipoma–Adrenal Medullary Infarction, Pheochromocytoma, or Acute Sympathetic Discharge? A Case Report and Literature Review

Ansari

Garza

Deavers

et al. 2015

AACE Clinical Case Reports

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Objective: To describe a case of hypertensive emergency following embolization of a large myelolipoma.Methods: Using the case report format to present clinical, laboratory, imaging, and dynamic testing data supporting clinical decision making. This is accompanied by a literature review.Results: A 40-year-old male with a history of hypertension presented with acute right upper abdominal pain and shortness of breath. Imaging completed at the transferring facility revealed a large right adrenal mass encapsulating the inferior vena cava. The blood hemoglobin was 7.8 g/dL because of internal hemorrhage into the mass. He underwent embolization of arterial flow to the right adrenal mass. A hypertensive emergency developed, and endocrinology was consulted to evaluate for pheochromocytoma. The plasma and urine normetanephrine were elevated, but the corresponding metanephrines remained normal. Surgery was imminent, and a clonidine suppression test in the surgical intensive care unit resulted in 60% suppression of plasma norepinephrine concentrations. He was cleared for surgery. The pathologic findings confirmed giant myelolipoma with internal hemorrhage.Conclusion: A giant myelolipoma with compressive effects can mimic a pheochromocytoma.

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Section: Discussionmentioning

confidence: 55%

“…Large tumors, termed giant myelolipomas, are rare and can present with hemorrhage and visceral compression, causing abdominal pain or inferior vena cava (IVC) compression (1,2). These tumors are commonly unilateral and rarely bilateral (3).…”

Section: Introductionmentioning

confidence: 99%

Hypertensive Emergency Following Embolization of a Large Adrenal Myelolipoma–Adrenal Medullary Infarction, Pheochromocytoma, or Acute Sympathetic Discharge? A Case Report and Literature Review

Ansari

Garza

Deavers

et al. 2015

AACE Clinical Case Reports

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“…Adrenal myelolipomas are diagnosed at an average age of 51 years and occur equally between male and female patients [3,4]. The etiology of adrenal myelolipomas remains unclear, although several hypotheses exist: 1) metaplastic changes of mesenchymal cortical cells in response to stress, infection, and/or necrosis, 2) metaplasia or hyperplasia of myeloid cells that migrated during embryogenesis in utero, 3) degeneration of adenomas or hyperplastic nodes within the adrenal cortex, 4) metaplasia of undifferentiated stromal cells, or 5) altered mesenchymal stem cell functions in the setting of abnormal hormonal stimuli [2,4,5,7]. In the context of CAH, it has been theorized that myelolipomas develop as a result of chronic stimulation of the adrenal glands by ACTH [6,11].…”

Section: Discussionmentioning

confidence: 99%

“…Management is usually with observation, although surgery may be indicated for large or increasing size, diagnostic ambiguity, or symptoms such as abdominal pain, constipation, or emesis. Congenital adrenal hyperplasia (CAH) has been reported to be associated with adrenal myelolipomas to varying rates [7][8][9], and few case reports describe giant adrenal myelolipomas (>10-cm) in the context of CAH [4,[10][11][12]. In this case report, we describe a giant adrenal myelolipoma incidentally diagnosed in a woman with CAH who had previously undergone contralateral adrenalectomy.…”

Section: Introductionmentioning

confidence: 93%

Giant Adrenal Myelolipoma and Congenital Adrenal Hyperplasia: A Case Report and Review of the Literature

Chen

Justo

Ojukwu

et al. 2022

Preprint

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Purpose: Adrenal myelolipomas (AMs) are rare, benign tumors without endocrine activity comprised of mature adipose and hematopoietic tissue. Surgical excision may be required for lesions which have associated symptoms, those that are growing, or have features concerning for malignancy. Congenital adrenal hyperplasia (CAH) is often associated with adrenal masses such as AM. The majority of literature regarding AMs consists of case reports and case series with few describing giant AMs in the context of CAH. Case Report: We present the case of a 50-year-old woman with CAH and surgical history relevant for left adrenalectomy who presented to the emergency department with abdominal pain. Computed tomography (CT) imaging led to a diagnosis of diverticulitis which was treated non-operatively. Their scan also revealed a 20x13x23-cm right retroperitoneal mass causing mass effect on the duodenum, pancreas, right kidney, and inferior vena cava. CT-guided biopsy demonstrated adrenal and adipose tissue with hematolymphoid aggregates possibly representing myelolipoma but unable to rule out malignancy. Due to concern for retroperitoneal liposarcoma, the patient underwent an exploratory laparotomy, resection of >40-cm right retroperitoneal mass, right nephrectomy, right adrenalectomy, and cholecystectomy. Final pathology demonstrated a myelolipoma with intra-tumoral ossification and hemorrhage as well as diffuse cortical hyperplasia with lymphoid aggregates. Due to acquired complete adrenal insufficiency, the patient required stress-dose steroids and steroid taper post-operatively.Conclusion: Key points from this report include the occurrence of a giant AM in the context of CAH and special considerations in the diagnosis and operative approach of a giant retroperitoneal mass.

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“…Because of this, myelolipomas have been considered as an atypical variant of multiple endocrine neoplasia, while others recommend grouping with another group of tumors such as lipomas, teratomas, liposarcomas or angiomyolipomas. In spite of having benign characteristics, the histopathological study and immunohistochemical evaluation is recommended, due to factors that increase the risk of malignancy [10]. The presence of hypertension has also been associated with myelolipoma; among the theories of this relationship, the renovascular mechanism by tumor compression has been postulated, however, other authors consider it an incidental finding in patients with obesity and advanced age [8].…”

Section: Discussionmentioning

confidence: 99%

Giant Adrenal Myelolipoma as a Cause of Chronic Abdominal Pain: Abdominal Pain due to Giant Myelolipoma

Hugo¹,

Ivan²,

Carlos³

et al. 2021

JSRP

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Adrenal myelolipomas are a benign and infrequent tumor, with adipose and hematopoietic composition; generally asymptomatic, in which the size varies from a few millimeters to some large ones that cause symptoms due to compression (mainly chronic and diffuse abdominal pain). We present the case of a 54 year old male patient with a long-term clinical course characterized by chronic abdominal pain, constipation and progressive volume increase, a large retroperitoneal mass was observed in the computerized tomography, so he underwent surgery for tumoral resection obtaining histopathological result of adrenal myelolipoma.

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Giant Adrenal Myelolipoma

Cited by 13 publications

References 8 publications

Hypertensive Emergency Following Embolization of a Large Adrenal Myelolipoma–Adrenal Medullary Infarction, Pheochromocytoma, or Acute Sympathetic Discharge? A Case Report and Literature Review

Hypertensive Emergency Following Embolization of a Large Adrenal Myelolipoma–Adrenal Medullary Infarction, Pheochromocytoma, or Acute Sympathetic Discharge? A Case Report and Literature Review

Giant Adrenal Myelolipoma and Congenital Adrenal Hyperplasia: A Case Report and Review of the Literature

Giant Adrenal Myelolipoma as a Cause of Chronic Abdominal Pain: Abdominal Pain due to Giant Myelolipoma

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