Myelolipomatous Adrenal Adenoma and Adrenal Scintigraphy: A Case Presentation and Review of Literature

Abstract

Adrenal myelolipomas are usually benign and non-functioning masses. On the other hand, adrenal myelolipomatous adenoma that may mimic adrenal myelolipoma on conventional imaging may be a rare cause of subclinical Cushing’s disease. Adrenal scintigraphy (with ¹³¹I-6beta-iodomethyl-19-norcholesterol) can be used to demonstrate increased uptake in a functioning adrenal myelolipomatous adenoma to distinguish it from an adrenal myelolipoma, when the source of the excess hormone secretion after biochemical evaluation is unclear. Treating physicians should be familiar with the occasional use of this imaging modality that can help distinguish functional adrenal tumors from non-functioning ones when conventional imaging fails to do so. A 66-year-old female was found to have an incidental 6.5 cm right adrenal mass during a routine abdominal ultrasound. Complete biochemical evaluation was suggestive of subclinical Cushing’s syndrome. Imaging studies were consistent with adrenal myelolipoma. Adrenal scintigraphy showed a unilateral increased uptake at the site of the adrenal mass. She successfully underwent laparoscopic adrenalectomy of the 6.5 cm mass and she had significant clinical improvement. Myelolipomatous adrenal adenoma (that may mimic adrenal myelolipoma on conventional imaging) may be a rare cause of subclinical Cushing’s, and adrenal scintigraphy may be a useful imaging technique that may help in localizing the lesion, which can then be treated surgically.




J Endocrinol Metab. 2014;4(5-6):148-150
doi: http://dx.doi.org/10.14740/jem254w