Adrenal myelolipoma
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Roukoz A. Karam, M.D.[2]
Synonyms and keywords:
Overview
Historical Perspective
Adrenolipoma was first discovered by Gierke in 1905.
Classification
Myelolipomas are classified into 4 type based on their clinicopathologic patterns:
- Isolated adrenal myelolipoma
- Adrenal myelolipoma with acute hemorrhage
- Extra-adrenal myelolipoma
- Myelolipoma associated with other adrenal diseases.
Clinicopathologic patterns | Description | Symptoms |
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Isolated Adrenal Myelolipoma |
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Adrenal Myelolipoma with Acute Hemorrhage |
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Extra-adrenal Myelolipoma |
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Adrenal Myelolipoma with Associated Adrenal Disease |
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Pathophysiology
- Myelolipomas are usually less than 4 cm in size occasionally measuring more than 10 cm in size.
- Extra-adrenal sites for myelolipomas include the retroperitoneum, thorax, and pelvis.
- Usually unilateral however they can also involve both adrenals.
- One hypothesis suggests that stimuli, such as necrosis, inflammation, infection, or stress could cause adrenocortical cell metaplasia
- If chronically present these stimulants lead to the development of neoplasms.
- This hypothesis is supported by the increased incidence of the lesion in the advanced years of life
Causes
The exact causes of Adrenal myelolipoma remain unknown. However, Adrenal myelolipoma is often associated with conditions that can be considered as adrenal stimulants such as:
- Cushing's disease
- Obesity
- Hyperlipidemia
- Hypertension
- Diabetes
- Stressful lifestyle
- Unbalanced diet
Differentiating adrenal myelolipoma from Other Diseases
Epidemiology and Demographics
- The incidence of adrenolipoma is approximately 0.8-4 per 100,000 individuals worldwide.
- Adrenolipoma affects men and women equally.
- Adrenolipomas are usually recognized in adults, either incidentally at ultrasound or computed topography or may present with vague abdominal symptoms if complicated by hemorrhage.
Risk Factors
There are no established risk factors for Adrenal myelolipoma.
Screening
There is insufficient evidence to recommend routine screening for Adrenal myelolipoma.
Natural History, Complications, and Prognosis
Diagnosis
Diagnostic Study of Choice
The diagnosis of Adrenal myelolipoma is made when
History and Symptoms
The majority of patients with Adrenal myelolipoma are asymptomatic.
Physical Examination
Common physical examination findings of Adrenal myelolipoma include
Laboratory Findings
Electrocardiogram
There are no ECG findings associated with Adrenal myelolipoma.
X-ray
There are no x-ray findings associated with Adrenal myelolipoma.
Echocardiography or Ultrasound
There are no echocardiography/ultrasound findings associated with Adrenal myelolipoma.
CT scan
Abdominal CT scan may be helpful in the diagnosis of Adrenal myelolipoma. Findings on CT scan suggestive of/diagnostic of Adrenal myelolipoma include
MRI
There are no MRI findings associated with Adrenal myelolipoma.
Other Imaging Findings
There are no other imaging findings associated with Adrenal myelolipoma.
Other Diagnostic Studies
There are no other diagnostic studies associated with Adrenal myelolipoma.
Treatment
Medical Therapy
There is no treatment for Adrenal myelolipoma; the mainstay of therapy is supportive care.
Surgery
Surgery is not the first-line treatment option for patients with Adrenal myelolipoma. Surgery is usually reserved for patients with either
Primary Prevention
There are no established measures for the primary prevention of Adrenal myelolipoma.
Secondary Prevention
There are no established measures for the secondary prevention of Adrenal myelolipoma.