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.
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.
The hormonal evaluation revealed adrenocorticotropic hormone (ACTH) dependent Cushing syndrome.
The patient underwent left adrenalectomy, and transsphenoidal resection of a pituitary mass. The final diagnosis was adrenal myelolipoma associated with Cushing disease.
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.
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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aDivision of Endocrinology and Metabolism, Departments of Internal Medicine
bDepartments of Pathology, Soon Chun Hyang University College of Medicine
cDivision of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine
dDepartment of Diagnostic Pathology, Samkwang Medical Laboratories, Seoul, Korea.
Correspondence: Dong Won Byun, Division of Endocrinology and Metabolism, Department of Internal Medicine, Soon Chun Hyang University College of Medicine, 657–58 Hannam-dong, Yonsan-gu, Seoul 140–743, Korea (e-mail: email@example.com).
Abbreviations: ACTH = adrenocorticotropic hormone, CT = computed tomography, IPSS = inferior petrosal sinus sampling, MRI = magnetic resonance imaging.
SYP and MKK contributed equally to this work.
This research was supported by the Soonchunhyang University Research Fund.
The authors declare no conflicts of interest.
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Received May 20, 2017
Received in revised form December 5, 2017
Accepted December 6, 2017