Case Report: An incidentaloma that catches your eye - adrenal myelolipoma [version 1; referees: 2 approved]
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Fecha
2017-07-18
Autores
D'Addosio, Rosanna
Rojas, Joselyn
Bermúdez, Valmore
Ledesma, Flor
Hoedebecke, Kyle
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Editor
F1000 Research Limited
Resumen
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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Palabras clave
Adrenal tumors, Etiology