OBJECTIVE: We aimed to describe clinical course of myelolipoma and to identify predictors of tumour growth and need for surgery. DESIGN: A retrospective study. PATIENTS: Consecutive patients with myelolipoma. RESULTS: A total of 321 myelolipomas (median size, 2.3 cm) were diagnosed in 305 patients at median age of 63 years (range, 25-87). Median follow-up was 54 months. Most myelolipomas were incidentally detected (86%), whereas 9% were discovered during cancer staging and 5% during workup of mass effect symptoms. Thirty-seven (12%) patients underwent adrenalectomy. Compared to myelolipomas <6 cm, tumours ≥6 cm were more likely to be bilateral (21% vs 3%, P < .0001), cause mass effect symptoms (32% vs 0%, P < .0001), have haemorrhagic changes (14% vs 1%, P < .0001) and undergo adrenalectomy (52% vs 5%, P < .0001). Among patients with ≥6 months of imaging follow-up, median size change was 0 mm (-10, 115) and median growth rate was 0 mm/y (-6, 14). Compared to <1 cm growth, ≥1 cm growth correlated with larger initial size (3.6 vs 2.3 cm, P = .02), haemorrhagic changes (12% vs 2%, P = .007) and adrenalectomy (35% vs 8%, P < .0001). CONCLUSIONS: Most myelolipomas are incidentally discovered on cross-sectional imaging. Myelolipomas ≥6 are more likely to cause mass effect symptoms, have haemorrhagic changes and undergo resection. Tumour growth ≥1 cm is associated with larger myelolipoma and haemorrhagic changes. Adrenalectomy should be considered in symptomatic patients with large tumours and when there is evidence of haemorrhage or tumour growth.

Department of Endocrinology and Metabolism Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City Mexico

Department of Internal Medicine Mayo Clinic Rochester MN USA

Department of Medicine Charles University Prague Czech Republic

Department of Surgery Mayo Clinic Rochester MN USA

Division of Endocrinology and Metabolism UT Southwestern Medical Center Dallas TX USA

Division of Endocrinology Diabetes and Nutrition Mayo Clinic Rochester MN USA

See more in PubMed

Lam AK-yJEp. Update on adrenal tumours in 2017 World Health Organization (WHO) of endocrine tumours. 2017;28(3):213–227. PubMed

Khater N, Khauli RJAjou. Myelolipomas and other fatty tumours of the adrenals. 2011;9(4):259–265. PubMed PMC

Olsson CA, Krane RJ, Klugo RC, Selikowitz SMJS. Adrenal myelolipoma. 1973;73(5):665–670. PubMed

Decmann Á, Perge P, Tóth M, Igaz P. Adrenal myelolipoma: a comprehensive review. Endocrine. 2018;59(1):7–15. PubMed

Low G, Dhliwayo H, Lomas DJCr. Adrenal neoplasms. 2012;67(10):988–1000. PubMed

Lam K, Lo CJJocp. Adrenal lipomatous tumours: a 30 year clinicopathological experience at a single institution. 2001;54(9):707–712. PubMed PMC

Selye H, Stone HJTAjop. Hormonally Induced Transformation Of Adernal into Myeloid Tissue. 1950;26(2):211. PubMed PMC

Sieber S, Gelfman N, Dandurand R, Braza FJCm. Ectopic ACTH and adrenal myelolipoma. 1989;53(1):7–10. PubMed

Song JH, Chaudhry FS, Mayo-Smith WWJAJoR. The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. 2008;190(5):1163–1168. PubMed

Bin X, Qing Y, Linhui W, Li G, Yinghao S. Adrenal incidentalomas: experience from a retrospective study in a Chinese population. Paper presented at: Urologic Oncology: Seminars and Original Investigations 2011. PubMed

Mantero F, Masini A, Opocher G, Giovagnetti M, Arnaldi GJH. Adrenal incidentaloma: an overview of hormonal data from the National Italian Study Group. 1997;47(4-6):284–289. PubMed

Shenoy VG, Thota A, Shankar R, Desai MGJIjouIjotUSoI. Adrenal myelolipoma: controversies in its management. 2015;31(2):94. PubMed PMC

Decmann Á, Perge P, Tóth M, Igaz PJE. Adrenal myelolipoma: a comprehensive review. 2018;59(1):7–15. PubMed

Fassnacht M, Arlt W, Bancos I, 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. 2016;175(2):G1–G34. PubMed

Vaidya A, Hamrahian A, Bancos I, Fleseriu M, Ghayee HKJEP. THE EVALUATION OF INCIDENTALLY DISCOVERED ADRENAL MASSES. 2019;25(2):178–192. PubMed

Campbell MJ, Obasi M, Wu B, Corwin MT, Fananapazir GJE. The radiographically diagnosed adrenal myelolipoma: what do we really know? 2017;58(2):289–294. PubMed

Zhao J, Sun F, Jing X, et al. The diagnosis and treatment of primary adrenal lipomatous tumours in Chinese patients: A 31-year follow-up study. 2014;8(3-4):E132. PubMed PMC

Han M, Burnett A, Fishman EK, Marshall FJTJou. The natural history and treatment of adrenal myelolipoma. 1997;157(4):1213–1216. PubMed

Yamashita S, Ito K, Furushima K, et al. Laparoscopic versus open adrenalectomy for adrenal myelolipoma. 2014;3(2):34–38. PubMed PMC

Chaudhary R, Deshmukh A, Singh K, Biswas RJBcr. Is size really a contraindication for laparoscopic resection of giant adrenal myelolipomas? 2016;2016:bcr2016215048. PubMed PMC

Agrusa A, Romano G, Frazzetta G, et al. Laparoscopic adrenalectomy for large adrenal masses: single team experience. 2014;12:S72–S74. PubMed

Liu H-P, Chang W-Y, Chien S- T, et al. Intra-abdominal bleeding with hemorrhagic shock: a case of adrenal myelolipoma and review of literature. 2017;17(1):74. PubMed PMC

Sebastia M, Perez-Molina M, Alvarez-Castells A, Quiroga S, Pallisa EJEr. CT evaluation of underlying cause in spontaneous subcapsular and perirenal hemorrhage. 1997;7(5):686–690. PubMed

Identification of potential molecular targets for the treatment of cluster 1 human pheochromocytoma and paraganglioma via comprehensive proteomic characterization