Rare case of symptomatic adrenal myelolipoma
- Anna Pokrovskaya ,
- Aida Tarzimanova ,
- Maria Vetluzhskaya and
- Valery Podzolkov
- Department of Faculty Therapy # 2, I M Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
- Correspondence to Dr Maria Vetluzhskaya; maria.vetluzhskaya@gmail.com
Description
A 36-year-old man presented to the clinic with frequent headaches and a brief episode of fainting. He said that he had experienced headache for a few months and occasionally had found his arterial pressure to be elevated at 180/120 mm Hg. He sometimes felt feverish and shivering all over, which was accompanied by sweating and then strong fatigue. The patient did not experience any abdominal or lower back pain. He denied having any other medical conditions. He stated that he had lost 40 kg over the past year without taking any medications. This weight loss reduced dyspnoea on exertion that had interfered with the patient’s daily activity. His family history and social status were unremarkable. On physical examination, his height was 177 cm; weight 110 kg; body mass index (BMI) 35.1 kg/m2. Vital signs were blood pressure (BP) 160/115 mm Hg, pulse 90 bpm, respiratory rate 18 breaths per minute. The abdomen was asymmetrically enlarged on its right side, with a painless and immobile mass of dense elastic consistency palpable in his right upper quadrant. The complete blood count (CBC) revealed decreased haemoglobin (119 g/L; reference ranges 135–165 g/L) and low red blood cells count (3.7×1012 /L; reference ranges 4.2–5.5×1012/L). Basic metabolic panel (BMP) revealed decreased level of total protein (59.6 g/L; reference ranges 66–83 g/L) and slight hyperglycaemia up to 6.5 mmol/L (reference ranges 3.9–5.8 mmol/L). Other parameters of BMP as well as liver function test, coagulation panel and urinalysis were normal. Changes in CBC and BMP were interpreted as a result of continuous unbalanced diet in order to lose weight. The patient’s glomerular filtration rate was 110 mL/min/1.73 m2 established by CKD-EPI equation. Ultrasound of kidneys and adrenal glands revealed a mass on the right adrenal gland. No kidney disease was confirmed. Abdominal CT found a voluminous mass of adipose density in the right-hand mesogastrium, 233×181×257 mm in size, thinly encapsulated and closely adjacent to the right adrenal gland; the latter’s dimensions were unaltered (figure 1). The giant size of the tumour and its clinical manifestation with arterial hypertension were the indications for surgery. The patient was laparotomised and the tumour of his right adrenal removed (video 1, figures 2 and 3). Histopathological examination revealed myelolipoma. The postoperative period was unremarkable. On a follow-up visit 2 months later, the patient had no complaints and reported no shivering, tachycardia or sweating episodes. His BP achieved normal values. His BMI was 30.2 kg/m2.
Abdominal CT with a mass near the right adrenal gland.
Laparotomic excision of the myelolipoma.
Adrenal myelolipoma.
Ethics statements
Patient consent for publication
Acknowledgments
We would like to acknowledge all the surgical team of the City Clinical Hospital named by VP Demichov, Department of Health, Moscow, RF, especially surgeon Kupriyanov EY and Head of Surgical Department #1 Soshkin NN. We would also like to acknowledge our reviewers and all people who have contributed significantly in this case editing and publishing.
Footnotes
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Twitter @Anna Pokrovskaya
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Contributors MV, AP, AT and VP participated in data collection, interpretation and article concept planning. AP participated in the writing of the manuscript; VP edited the manuscript. All authors have read the final version of the manuscript and agree for publication.
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Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
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Competing interests None declared.
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Provenance and peer review Not commissioned; externally peer reviewed.
- © BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.
References
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