Endocrine Abstracts

Introduction: Adrenal myelolipoma is a rare, benign and nonfunctional tumor composed of mature adipose and hematopoietic cells. It is often of incidental finding (8%) and the diagnosis is based on radiological imaging. We report two cases of giant adrenal myelolipoma and discuss the diagnostic and therapeutic aspects of this pathology.

Observation: Patient D.K 40 years old, hospitalized for adrenal mass revealed by right back pain radiating to the right hypochondrium, without signs of endocrine hypersecretion. Clinical examination showed sensitivity of the right lumbar fossa. 24-hours urinary methoxyl derivatives and dexamethasone suppression test were correct. The patient underwent the removal of the abdominal masse and anatomo-pathological examination showed adrenal myelolipoma. Patient A.M, 51 years old, with a personal history of simple mammary and renal cysts, consulted for an adrenal incidentaloma of 65 cm discovered on pelvic MRI during exploration of myxomatous uterus. Clinically, the patient did not present signs of endocrine hypersecretion or abdominal pain. Hormone levels returned normal. Abdominal scan revealed a large left adrenal mass with spontaneous density of – 45 HU, heterogeneous, 60*18*78 mm, without any sign of vascular invasion or neighbouring organs. The patient underwent a left adrenalectomy. Anatomopathological study showed adrenal myolipoma.

Conclusion: Unlike other adrenal incidentalomas, adrenal myelolipoma is a rare, benign tumor that is often asymptomatic with special radiological features. Management is based on clinical and radiological follow up of asymptomatic forms. Surgical treatment is reserved for large, symptomatic or complicated adrenal myelolipomas.