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Adrenal myelolipoma: a comprehensive review

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Abstract

Introduction

Adrenal myelolipoma is an invariably benign neoplasm of the adrenal gland that is the second most common primary adrenal incidentaloma following adrenocortical adenomas. It is composed of elements of adipose tissue and extramedullary hematopoiesis. Hypotheses on stem cells and hormonal factors have been formulated regarding its pathogenesis that is still obscure. Despite its benign behavior, adrenal myelolipoma is clinically relevant as it might cause significant difficulties in the differential diagnosis of adrenal tumors.

Methods

We have reviewed 420 cases reported between 1957 and 2017 on adrenal myelolipoma retrieved from PubMed and Scopus databases and also 20 of our case series to provide a comprehensive analysis of their pathology, epidemiological and clinical features.

Results and Conclusions

The average age for its diagnosis was 51 years, and no gender difference was observed. The average size of tumors was 10.2 cm. Congenital adrenal hyperplasia was associated to 10% of all cases analyzed, while other adrenal hypersecretory disorders (cortisol, aldosterone) were found in 7.5% of cases. Computed tomography and magnetic resonance imaging can be reliably used for its differential diagnosis. If the diagnosis of an adrenal myelolipoma is unambiguous, and no associated symptoms or hormonal activity are established, surgical intervention is usually not necessary.

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Abbreviations

ACTH:

adrenocorticotropic hormone

AML:

adrenal myelolipoma

CAH:

congenital adrenal hyperplasia

EMH:

extramedullary hematopoiesis

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Acknowledgements

The study has been supported by a grant from the Hungarian National Research, Development and Innovation Office (NKFIH K115398) to Dr. Peter Igaz. The authors would like to thank Dr. Katalin Borka MD PhD for providing a microscopic picture of myelolipoma and pathologic data of our case series.

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Authors and Affiliations

  1. 2nd Department of Medicine, Semmelweis University, Szentkirályi str. 46., Budapest, 1088, Hungary

    Ábel Decmann, Pál Perge, Miklós Tóth & Peter Igaz

  2. MTA-SE Molecular Medicine Research Group, Hungarian Academy of Sciences and Semmelweis University, Szentkirályi str. 46., Budapest, 1088, Hungary

    Peter Igaz

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  1. Ábel Decmann
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Decmann, Á., Perge, P., Tóth, M. et al. Adrenal myelolipoma: a comprehensive review. Endocrine 59, 7–15 (2018). https://doi.org/10.1007/s12020-017-1473-4

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