Abstract
Purpose
Adrenal myelolipomas are uncommon, benign tumors of the adrenal glands that are not routinely evaluated for autonomous hormone secretion or followed by repeat imaging, but may lead to retroperitoneal hemorrhage. Little is known about the natural history these tumors with the majority of previous publications being confined to case reports and small case series.
Methods
We reviewed the computed tomography (CT) reports of 62,279 patients evaluated at a tertiary referral center between 2002 and 2015 for the presence of an adrenal myelolipoma >1 cm in size. We then reviewed the CT imaging and patient charts to determine tumor size, growth, evidence of retroperitoneal hemorrhage, and endocrine dysfunction.
Results
We identified 150 (0.24%) patients with 155 radiographically diagnosed adrenal myelolipomas found on a CT scan during our study period. The median tumor size at discovery was 2.1 cm. Twelve (7.7%) tumors were >6 cm. Sixty-nine (46%) patients had a follow-up CT with a mean time interval between scans of 3.9 years. Eleven tumors (16%) grew over our follow-up period with a median growth rate of 0.16 cm/year. No patient developed a retroperitoneal hemorrhage. Twenty (13%) patients underwent an evaluation for endocrine dysfunction. Three patients had evidence of hypercortisolism and one patient had primary aldosteronism.
Conclusion
The majority of radiographically diagnosed adrenal myelolipomas found on abdominal CT imaging are small and slow growing. Retroperitoneal hemorrhage is uncommon, but the rate of associated endocrine dysfunction may be underestimated.
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References
J. Dinnes, I. Bancos, L. Ferrante di Ruffano et al., Management of endocrine disease: imaging for the diagnosis of malignancy in incidentally discovered adrenal masses: a systematic review and meta-analysis. Eur. J. Endocrinol. 175(2), R51–R64 (2016).
M. Fassnacht, W. Arlt, I. Bancos et al., Management of adrenal incidentalomas: European society of endocrinology clinical practice guideline in collaboration with the European network for the study of adrenal tumors. Eur. J. Endocrinol. 175(2), G1–G34 (2016).
M.A. Zeiger, G.B. Thompson, Q.Y. Duh et al., American association of clinical endocrinologists and American association of endocrine surgeons medical guidelines for the management of adrenal incidentalomas: executive summary of recommendations. Endocr. Pract. 15(5), 450–453 (2009).
L.L. Berland, S.G. Silverman, R.M. Gore et al., Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J. Am. Coll. Radiol. 7(10), 754–773 (2010).
A. Plaut, Myelolipoma in the adrenal cortex; myeloadipose structures. Am. J. Pathol. 34(3), 487–515 (1958).
K.Y. Lam, C.Y. Lo, Adrenal lipomatous tumors: a 30 year clinicopathological experience at a single institution. J. Clin. Pathol. 54(9), 707–712 (2001).
J.H. Song, F.S. Chaudhry, W.W. Mayo-Smith, The incidental adrenal mass on CT: prevalence of adrenal disease in 1049 consecutive adrenal masses in patients with no known malignancy. Am. J. Roentgenol. 190(5), 1163–1168 (2008).
E.M. Schaeffer, L.R. Kavoussi, Adrenal myelolipoma. J. Urol. 173(5), 1760 (2005).
V.G. Patel, O.A. Babalola, J.K. Fortson et al., Adrenal myelolipoma: report of a case and review of the literature. Am. Surg. 72(7), 649–654 (2006).
H.C. Su, X. Huang, W.L. Zhou et al., Pathologic analysis, diagnosis and treatment of adrenal myelolipoma. Can. Urol. Assoc. J. 8(9-10), E637–E640 (2014).
S. Daneshmand, M. Quek, Adrenal myelolipoma: diagnosis and management. Urol. J. 3(2), 71–74 (2006).
J. Vierna, J.B. Laforga, Giant adrenal myelolipoma. Report of a case and review of the literature. Scand. J. Urol. Nephrol. 28, 301–304 (1994).
V.G. Shenoy, A. Thota, R. Shankar et al., Adrenal myelolipoma: controversies in its management. Indian J Urol. 31(2), 94–101 (2015).
M. Nishino, J.P. Jagannathan, N.H. Ramaiya et al., Revised RECIST guideline version 1.1: what oncologists want to know and what radiologists need to know. Am. J. Roentgenol. 195(2), 281–289 (2010).
D. Mozaffarian, E.J. Benjamin, A.S. Go et al., Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation 133(4), e38–e360 (2016).
M. Han, A.L. Burnett, E.K. Fishman et al., The natural history and treatment of adrenal myelolipoma. J. Urol. 157(4), 1213–1216 (1997).
M. Peppa, E. Boutati, C. Koliaki et al., Insulin resistance and metabolic syndrome in patients with nonfunctioning adrenal incidentalomas: a cause–effect relationship. Metabolism 59(10), 1435–1441 (2010).
V.S. Katabathina, E. Flaherty, R. Kaza et al., Adrenal collision tumors and their mimics: multimodality imaging findings. Cancer Imaging 13(4), 602–610 (2013).
P.J. Kennedy, B.J. Wagner, P. Rao et al., Myelolipoma: CT and pathologic features. Radiology 208(1), 87–95 (1998).
P. Otal, G. Escourrou, C. Mazerolles et al., Imaging features of uncommon adrenal masses with histopathologic correlation. Radiographics 19(3), 569–581 (1999).
Acknowledgments
Department funds were used for incidental expenses. All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The requirement for informed consent was waived for this study by our institutional review board.
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Campbell, M.J., Obasi, M., Wu, B. et al. The radiographically diagnosed adrenal myelolipoma: what do we really know?. Endocrine 58, 289–294 (2017). https://doi.org/10.1007/s12020-017-1410-6
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DOI: https://doi.org/10.1007/s12020-017-1410-6