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Published on: September 15, 2017
Case report of a bilateral adrenal myelolipoma associated with Cushing disease
Se Yoon Park1, Mi Kyung Kwak, Hye Jeong Kim
1Division of Endocrinology and Metabolism, Departments of Internal Medicine Departments of Pathology, Soon Chun Hyang University College of Medicine Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine Department of Diagnostic Pathology, Samkwang Medical Laboratories, Seoul, Korea.
Rationale:
Adrenal myelolipomas are rare benign tumors, composed of a variable mixture of mature adipose tissue and hematopoietic tissue. These tumors are frequently detected incidentally and are usually asymptomatic, and hormonally inactive.
Patient Concerns:
During a routine health checkup, a 52-year-old man was found to have a tumor on the bilateral adrenal glands. Abdominal computed tomography revealed a well-defined, heterogeneously enhanced bilateral adrenal mass, suggesting a myelolipoma.
Diagnoses:
The hormonal evaluation revealed adrenocorticotropic hormone (ACTH) dependent Cushing syndrome.
Interventions:
The patient underwent left adrenalectomy, and transsphenoidal resection of a pituitary mass. The final diagnosis was adrenal myelolipoma associated with Cushing disease.
Outcomes:
Growth of right adrenal myelolipoma was detected during the 7-year follow-up. There were enhancing pituitary lesions in repeat magnetic resonance imaging of the sellar region, which implies persistent or recurrent pituitary adenoma. This case reinforces relationship between Cushing disease and adrenal myelolipoma.
Lessons:
To the best of our knowledge, this is the first reported pathologically confirmed bilateral adrenal myelolipoma associated with Cushing disease. This report supports the idea that ACTH is associated with the development of adrenal myelolipoma.
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