Bilateral symptomatic adrenal myelolipoma

Myelolipomas of the adrenal gland were first described in 1905. They are rare cortical, nonfunctioning, benign neoplasms, generally unilateral, usually discovered by accident or at autopsy. Thus they are often classified as 'incidentaloma'. These tumors are more frequent in males 40-60 years old. Most adrenal myelolipomas are small (diameter < 4 cm) and asymptomatic (70%), but larger tumors may cause local symptoms secondary to mechanical compression. Very large bilateral adrenal myelolipomas are exceedingly rare. They generally require no treatment; however, if symptomatics or if diagnosis is in doubt, surgery is needed. Usually only monolateral adrenalectomy is performed, even in the presence of bilateral tumors, to preserve adrenal function. We present a case of bilateral, symptomatic giant myelolipoma in a young woman, treated with bilateral adrenalectomy.