Symptomatic Adrenal Myelolipoma: A Case Report

Adrenal myelolipomas are lipomatous tumours containing myeloid cell elements that typically have a benign course. They account for 3.3-6.5% of all adrenal masses and are usually unilateral in 95% of cases. These tumours affect both sexes equally during midlife. While they are often asymptomatic, symptomatic cases may require surgery. The pathogenesis is believed to involve either metaplastic changes in mesenchymal cells or overstimulation by Adrenocorticotropic Hormone (ACTH). The present case involves a 49-year-old male who presented with abdominal pain and fullness lasting three months. Serum ACTH levels were within normal limits, with a mild elevation of 17-Hydroxyprogesterone (17-OHP). Radiological investigations, including both Ultrasonography (USG) and Computed Tomography (CT), described the lesion as a large, well-circumscribed, heterodense lesion in the left adrenal gland, which was identified as adrenal myelolipoma. Histopathological examination revealed a tumour comprised of adipocytes and extramedullary trilineage haematopoietic elements, confirming the diagnosis of adrenal myelolipoma. The significance of presenting this case lies in its large size, the definite clinical symptoms of abdominal pain and fullness, and the fact that it was unrelated to serum ACTH levels.