MON-499 Approach to Management of Large Asymptomatic Myelolipomas

Abstract Disclosure: H.B. Kang: None. N. Shah: None. Myelolipomas are rare, benign tumors composed of adipose tissue and hematopoietic elements that usually occur in the adrenal glands. In most cases these tumors are hormonally inactive and asymptomatic. Due to increasing use of cross-section imaging modalities, the incidental detection of myelolipomas is increasing. Symptomatic myelolipomas can present with abdominal or flank pain. Serious complications of myelolipomas include hemorrhage, spontaneous rupture, and necrosis. A 67-year-old male with PMH of CAD, HTN, HLD presented to the ED for symptoms of acute dyspnea. During diagnostic workup, a CT chest angiogram was obtained to rule out a pulmonary embolism. Radiographic findings included no evidence of PE and an incidental finding of a 13 x 10 x 9.5 cm fat-containing right adrenal mass. After discharge, he was referred by his PCP to endocrinology for further input regarding evaluation and management of the right adrenal mass. During the consultation visit, the patient’s physical exam was unremarkable with patient denying pain in right abdomen and flank on palpation. Biochemical evaluation for hormonal secretion was negative with unremarkable results of 1mg dexamethasone suppression test and normal serum levels of aldosterone and catecholamines. A dedicated CT abdomen pelvis with and without contrast was obtained which noted a 12 x 9.5 x 11 cm right adrenal mass predominantly composed of fatty elements with a few areas of scattered soft tissue density suspicious for myelolipoma. This suspicion was further supported by a radiographic density of -96 Hounsfield units in most of the mass with -17HU in the scattered solid components of the mass. Upon further discussion with patient, he opted for surgical removal and is undergoing preoperative evaluation with input from urology, cardiology, endocrinology, and anesthesiology. While there is general agreement that surgical removal is warranted when myelolipomas are symptomatic or if there is biochemical evidence of hormone-secretion, there is no consensus regarding treatment approach of large, asymptomatic myelolipomas. Options for management include a conservative approach with radiographic monitoring and definitive treatment with surgical removal. Hypothetically, larger myelolipomas would be more likely to be symptomatic or associated with complications such as hemorrhage, but current literature has not shown clear evidence of this association. Ultimately, the decision for managing large asymptomatic myelolipomas will require multidisciplinary, in-depth discussions between the patient and physician, considering the patient's comorbidities, surgical risk, and preferences. Presentation: Monday, July 14, 2025