, Volume 59, Issue 1, pp 7–15 | Cite as

Adrenal myelolipoma: a comprehensive review

  • Ábel Decmann
  • Pál Perge
  • Miklós Tóth
  • Peter IgazEmail author



Adrenal myelolipoma is an invariably benign neoplasm of the adrenal gland that is the second most common primary adrenal incidentaloma following adrenocortical adenomas. It is composed of elements of adipose tissue and extramedullary hematopoiesis. Hypotheses on stem cells and hormonal factors have been formulated regarding its pathogenesis that is still obscure. Despite its benign behavior, adrenal myelolipoma is clinically relevant as it might cause significant difficulties in the differential diagnosis of adrenal tumors.


We have reviewed 420 cases reported between 1957 and 2017 on adrenal myelolipoma retrieved from PubMed and Scopus databases and also 20 of our case series to provide a comprehensive analysis of their pathology, epidemiological and clinical features.

Results and Conclusions

The average age for its diagnosis was 51 years, and no gender difference was observed. The average size of tumors was 10.2 cm. Congenital adrenal hyperplasia was associated to 10% of all cases analyzed, while other adrenal hypersecretory disorders (cortisol, aldosterone) were found in 7.5% of cases. Computed tomography and magnetic resonance imaging can be reliably used for its differential diagnosis. If the diagnosis of an adrenal myelolipoma is unambiguous, and no associated symptoms or hormonal activity are established, surgical intervention is usually not necessary.


Adrenal myelolipoma Congenital adrenal hyperplasia Differential diagnosis Management 



adrenocorticotropic hormone


adrenal myelolipoma


congenital adrenal hyperplasia


extramedullary hematopoiesis



The study has been supported by a grant from the Hungarian National Research, Development and Innovation Office (NKFIH K115398) to Dr. Peter Igaz. The authors would like to thank Dr. Katalin Borka MD PhD for providing a microscopic picture of myelolipoma and pathologic data of our case series.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests

Supplementary material

12020_2017_1473_MOESM1_ESM.xlsx (64 kb)
Supplementary Information


  1. 1.
    A.K. Lam, Update on adrenal tumours in 2017 World Health Organization (WHO) of Endocrine Tumours. Endocr. Pathol. 1–15 (2017).
  2. 2.
    C.A. Olsson, R.J. Krane, R.C. Klugo, S.M. Selikowitz, Adrenal myelolipoma. Surgery 73, 665–670 (1973)PubMedGoogle Scholar
  3. 3.
    J.H. Song, F.S. Chaudhry, W.W. Mayo-Smith, The incidental adrenal mass on CT: Prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. Am. J. Roentgenol. 190, 1163–1168 (2008). CrossRefGoogle Scholar
  4. 4.
    X. Bin, Y. Qing, W. Linhui, G. Li, S. Yinghao, Adrenal incidentalomas: Experience from a retrospective study in a Chinese population. J. Urol. 29, 270–274 (2011). Google Scholar
  5. 5.
    F. Mantero, A.M. Masini, G. Opocher, M. Giovagnetti, G. Arnaldi, Tumors, on behalf of the N.I.S.G. on A., Adrenal incidentaloma: An overview of hormonal data from the National Italian Study Group. Horm. Res. 47, 284–289 (1997). CrossRefPubMedGoogle Scholar
  6. 6.
    Y. Minamiya, S. Abo, M. Kitamura, K. Izumi, Mediastinal extraadrenal myelolipoma: report of a case. Surg. Today 27, 971–972 (1997)CrossRefPubMedGoogle Scholar
  7. 7.
    Y. Zeng, Q. Ma, L. Lin, P. Fu, Y. Shen, Q.-Y. Luo, L.-H. Zhao, J.-H. Mou, H.-L. Xiao, Giant myelolipoma in the spleen: A rare case report and literature review. Int. J. Surg. Pathol. 24, 177–180 (2016). CrossRefPubMedGoogle Scholar
  8. 8.
    M. Ghaouti, K. Znati, A. Jahid, F. Zouaidia, Z. Bernoussi, N. Mahassini, Renal myelolipoma: a rare extra-adrenal tumor in a rare site: a case report and review of the literature. J. Med. Case Rep. 7, 92 (2013). CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    M. Sundaram, T. Bauer, A. von Hochstetter, H. Ilaslan, M. Joyce, Intraosseous myelolipoma. Skelet. Radiol. 36, 1181–1184 (2007). CrossRefGoogle Scholar
  10. 10.
    M. Krismann, G. Reichle, K.M. Müller, [Thoracic bilateral myelolipoma]. Pneumologie 47, 501–503 (1993)PubMedGoogle Scholar
  11. 11.
    S.A. George, M.T. Manipadam, R. Thomas, Primary myelolipoma presenting as a nasal cavity polyp: a case report and review of the literature. J. Med. Case Rep. 6, 127 (2012). CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    S.H. Stein, F. Latour, S.S. Frost, Myelolipoma arising from ectopic adrenal cortex: case report and review of the literature. Am. J. Gastroenterol. 81, 999–1001 (1986)PubMedGoogle Scholar
  13. 13.
    S.J. Cina, B.M. Gordon, N.S. Curry, Ectopic adrenal myelolipoma presenting as a splenic mass. Arch. Pathol. Lab. Med. 119, 561–563 (1995)PubMedGoogle Scholar
  14. 14.
    S.J. Newman, K. Inzana, W. Chickering, Extradural myelolipoma in a dog. J. Vet. Diagn. Investig. 12, 71–74 (2000). CrossRefGoogle Scholar
  15. 15.
    G. Storms, G. Janssens, Intraocular myelolipoma in a dog. Vet. Ophthalmol. 16, 183–187 (2013). CrossRefPubMedGoogle Scholar
  16. 16.
    Taher, A., Vichinsky, E., Musallam, K., Cappellini, M.D., Viprakasit, V., Weatherall, S.D.: Guidelines for the management of non transfusion dependent thalassaemia (NTDT). Thalassaemia International Federation (2013).
  17. 17.
    M.R. Fowler, R.B. Williams, J.M. Alba, C.R. Byrd, Extra-adrenal myelolipomas compared with extramedullary hematopoietic tumors: a case of presacral myelolipoma. Am. J. Surg. Pathol. 6, 363–374 (1982)CrossRefPubMedGoogle Scholar
  18. 18.
    Chen, K.T.K., Felix, E.L., Flam, M.S.: Extraadrenal myelolipoma. Am. J. Clin. Pathol. 78, 386–389 (1982)Google Scholar
  19. 19.
    R. Sanders, N. Bissada, N. Curry, B. Gordon, Clinical spectrum of adrenal myelolipoma: Analysis of eight tumors in seven patients. J. Urol. 153, 1791–1793 (1995). CrossRefPubMedGoogle Scholar
  20. 20.
    V.G. Shenoy, A. Thota, R. Shankar, M.G. Desai, Adrenal myelolipoma: Controversies in its management. Indian. J. Urol. 31, 94–101 (2015). Google Scholar
  21. 21.
    S. De Navasquez, Case of myelo-lipoma (bone-marrow, heterotopia) pf suprarenal gland. Guys. Hosp. Rep. 88, 237–240 (1935)Google Scholar
  22. 22.
    K.-C. Chang, P.-I. Chen, Z.-H. Huang, Y.-M. Lin, P.-L. Kuo, Adrenal myelolipoma with translocation (3;21)(q25; p11). Cancer Genet. Cytogenet 134, 77–80 (2002). CrossRefPubMedGoogle Scholar
  23. 23.
    E. Bishop, J.N. Eble, L. Cheng, M. Wang, D.R. Chase, A. Orazi, D.P. O’Malley, Adrenal myelolipomas show nonrandom X-chromosome inactivation in hematopoietic elements and fat: Support for a clonal origin of myelolipomas. Am. J. Surg. Pathol. 30, 838–843 (2006). CrossRefPubMedGoogle Scholar
  24. 24.
    C. Feng, H. Jiang, Q. Ding, H. Wen, Adrenal myelolipoma: A mingle of progenitor cells? Med. Hypotheses 80, 819–822 (2013). CrossRefPubMedGoogle Scholar
  25. 25.
    H. Selye, H. Stone, Hormonally induced transformation of adrenal into myeloid tissue. Am. J. Pathol. 26, 211–233 (1950)PubMedPubMedCentralGoogle Scholar
  26. 26.
    S.C. Sieber, N.A. Gelfman, R. Dandurand, F. Braza, Ectopic ACTH and adrenal myelolipoma. Conn. Med. 53, 7–10 (1989)PubMedGoogle Scholar
  27. 27.
    H. Hagiwara, T. Usui, T. Kimura, T. Tagami, M. Naruse, S. Minamiguchi, T. Kato, H. Okuno, A. Shimatsu, Lack of ACTH and androgen receptor expression in a giant adrenal myelolipoma associated with 21-hydroxylase deficiency. Endocr. Pathol. 19, 122–127 (2008). CrossRefPubMedGoogle Scholar
  28. 28.
    I. Motta, L. Boiocchi, P. Delbini, M. Migone De Amicis, E. Cassinerio, D. Dondossola, G. Rossi, M.D: Cappellini, A giant adrenal myelolipoma in a beta-thalassemia major patient: Does ineffective erythropoiesis play a role? Am. J. Hematol. 91, 1281–1282 (2016). CrossRefPubMedGoogle Scholar
  29. 29.
    B.P. Rubin, K.H. Allison, G.N. Mann, T.H. Norwood, An unusual case of multiple giant myelolipomas: Clinical and pathogenetic implications. Endocr. Pathol. 14, 93–100 (2003)CrossRefPubMedGoogle Scholar
  30. 30.
    Merchant, S.H., Herman, C.M., Amin, M.B., Ro, J.Y., Troncoso, P.: Myelolipoma associated with adrenal ganglioneuroma. Arch. Pathol. Lab. Med. 126, 736–737 (2002)Google Scholar
  31. 31.
    H. Lu, M. Gan, H. Chen, S. Huang, Adrenal myelolipoma within myxoid cortical adenoma associated with Conn’s syndrome. J. Zhejiang Univ. Sci. B. 9, 500–505 (2008). PubMedPubMedCentralGoogle Scholar
  32. 32.
    U. Kumar, S. Priyadarshi, V. Tomar, R.R. Vohra, Adrenal myelolipoma with osseous metaplasia and hypercortisolism. Urol. Ann. 9, 71–73 (2017). CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    R. Armand, A.R. Cappola, R.B. Horenstein, C.B. Drachenberg, H. Sasano, J.C. Papadimitriou, Adrenal cortical adenoma with excess black pigment deposition, combined with myelolipoma and clinical Cushing’s syndrome: A case report and review of the literature. Int. J. Surg. Pathol. 12, 57–61 (2004). CrossRefPubMedGoogle Scholar
  34. 34.
    B.F. Schwartz, L. Wasson, Hibernoma arising from the adrenal gland. Urology 61, 1035 (2003). CrossRefPubMedGoogle Scholar
  35. 35.
    I.A. Cardinalli, A.G. de Oliveira-Filho, M.J. Mastellaro, R.C. Ribeiro, S.S. Aguiar, A unique case of synchronous functional adrenocortical adenoma and myelolipoma within the ectopic adrenal cortex in a child with Beckwith–Wiedemann syndrome. Pathol. Res. Pract. 208, 189–194 (2012). CrossRefPubMedGoogle Scholar
  36. 36.
    M.C. Sebastià, M.O. Pérez-Molina, A. Alvarez-Castells, S. Quiroga, E. Pallisa, CT evaluation of underlying cause in spontaneous subcapsular and perirenal hemorrhage. Eur. Radiol. 7, 686–690 (1997). CrossRefPubMedGoogle Scholar
  37. 37.
    G. Low, H. Dhliwayo, D.J. Lomas, Adrenal neoplasms. Clin. Radiol. 67, 988–1000 (2012). CrossRefPubMedGoogle Scholar
  38. 38.
    K.Y. Lam, C.Y. Lo, Adrenal lipomatous tumours: a 30 year clinico- pathological experience at a single institution. J. Clin. Pathol. 54, 707–712 (2001)CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    A.K. Lam, Lipomatous tumours in adrenal gland: WHO updates and clinical implications. Endocr. Relat. Cancer 24, R65–R79 (2017). CrossRefPubMedGoogle Scholar
  40. 40.
    M. Han, A.L. Burnett, E.K. Fishman, F.F. Marshall, The natural history and treatment of adrenal myelolipoma. J. Urol. 157, 1213–1216 (1997). CrossRefPubMedGoogle Scholar
  41. 41.
    Campbell, M.J., Obasi, M., Wu, B., Corwin, M.T., Fananapazir, G.: The radiographically diagnosed adrenal myelolipoma: what do we really know? Endocrine. 1–6 (2017). doi:
  42. 42.
    H.-P. Liu, W.-Y. Chang, S.-T. Chien, C.-W. Hsu, Y.-C. Wu, W.-C. Kung, C.-M. Su, P.-H. Liu, Intra-abdominal bleeding with hemorrhagic shock: a case of adrenal myelolipoma and review of literature. BMC Surg. 17, 74 (2017). CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    A.A. Reza-Albarran, F.J. Gomez-Perez, J.C. Lopez, M. Herrera, A. Gamboa-Dominguez, C. Keirns, A. Aranda, J.A. Rull, Myelolipoma: A new adrenal finding in Carney’s complex? Endocr. Pathol. 10, 251–257 (1999)CrossRefPubMedGoogle Scholar
  44. 44.
    P. Kalafatis, Bilateral giant adrenal myelolipoma and polycystic ovarian disease. Urol. Int. 63, 139–143 (1999)CrossRefPubMedGoogle Scholar
  45. 45.
    M. Yoshioka, K. Fujimori, M. Wakasugi, N. Yamazaki, M. Kuroki, T. Tsuchida, H. Seki, M. Sekiya, T. Tamura, Cushing’s disease associated with adrenal myelolipoma, adrenal calcification and thyroid cancer. Endocr. J. 41, 461–466 (1994)CrossRefPubMedGoogle Scholar
  46. 46.
    S. Banik, P.S. Hasleton, R.L. Lyon, An unusual variant of multiple endocrine neoplasia syndrome: a case report. Histopathology 8, 135–144 (1984)CrossRefPubMedGoogle Scholar
  47. 47.
    I. Maschler, E. Rosenmann, E.N. Ehrenfeld, Ectopic functioning adrenocortico-myelolipoma in longstanding Nelson’s syndrome. Clin. Endocrinol. (Oxf.). 10, 493–7 (1979)CrossRefPubMedGoogle Scholar
  48. 48.
    F. Gemmel, H. Bruinsma, P. Oomen, J. Collins, PET/CT incidental detection of bilateral adrenal myelolipomas in a patient with a huge maxillary sinus carcinoma. Clin. Nucl. Med. 35, 132–133 (2010). CrossRefPubMedGoogle Scholar
  49. 49.
    V. Ludwig, M.H. Rice, W.H. Martin, M.C. Kelley, D. Delbeke, 2-Deoxy-2-[18F]fluoro-D-glucose positron emission tomography uptake in a giant adrenal myelolipoma. Mol. Imaging Biol. 4, 355–8 (2002)CrossRefPubMedGoogle Scholar
  50. 50.
    P. Boraschi, G. Braccini, R. Gigoni, F. Cartei, A. Campatelli, A. Di Vito, G. Perri, [Adrenal myelolipomas: their magnetic resonance assessment]. Clin. Ter. 147, 549–557 (1996)PubMedGoogle Scholar
  51. 51.
    Musante, F., Derchi, L.E., Bazzocchi, M., Avataneo, T., Gandini, G., Pozzi Mucelli, R.S.: MR imaging of adrenal myelolipomas. J. Comput. Assist. Tomogr. 15, 111–114 (1991)Google Scholar
  52. 52.
    D.J. Wale, K.K. Wong, B.L. Viglianti, D. Rubello, M.D. Gross, Contemporary imaging of incidentally discovered adrenal masses. Biomed. Pharmacother. 87, 256–262 (2017). CrossRefPubMedGoogle Scholar
  53. 53.
    M. Fassnacht, M. Kroiss, B. Allolio, Update in Adrenocortical Carcinoma. J. Clin. Endocrinol. Metab. 98, 4551–4564 (2013). CrossRefPubMedGoogle Scholar
  54. 54.
    M.L. Nunes, A. Rault, J. Teynie, N. Valli, M. Guyot, D. Gaye, G. Belleannee, A. Tabarin, 18F-FDG PET for the identification of adrenocortical carcinomas among indeterminate adrenal tumors at computed tomography scanning. World J. Surg. 34, 1506–1510 (2010). CrossRefPubMedGoogle Scholar
  55. 55.
    M. Fassnacht, W. Arlt, I. Bancos, H. Dralle, J. Newell-Price, A. Sahdev, A. Tabarin, M. Terzolo, S. Tsagarakis, O.M. Dekkers, Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur. J. Endocrinol. 175, G1–G34 (2016). CrossRefPubMedGoogle Scholar
  56. 56.
    Zhong, Y., Shen, Y., Pan, J., Wang, Y., An, Y., Guo, A., Ma, L., Ye, H., Wang, H.: Renal epithelioid angiomyolipoma: MRI findings. Radiol. Med. (2017). doi:
  57. 57.
    S. Krishna, C.A. Murray, M.D. McInnes, R. Chatelain, M. Siddaiah, O. Al-Dandan, S. Narayanasamy, N. Schieda, CT imaging of solid renal masses: pitfalls and solutions. Clin. Radiol. 72, 708–721 (2017). CrossRefPubMedGoogle Scholar
  58. 58.
    W.D. Craig, J.C. Fanburg-Smith, L.R. Henry, R. Guerrero, J.H. Barton, Fat-containing lesions of the retroperitoneum: Radiologic-pathologic correlation. RadioGraphics 29, 261–290 (2009). CrossRefPubMedGoogle Scholar
  59. 59.
    M. Terzolo, S. Bovio, A. Pia, G. Reimondo, A. Angeli, Management of adrenal incidentaloma. Best. Pract. Res. Clin. Endocrinol. Metab. 23, 233–243 (2009). CrossRefPubMedGoogle Scholar
  60. 60.
    R. Libè, C. Dall’Asta, L. Barbetta, A. Baccarelli, P. Beck-Peccoz, B. Ambrosi, Long-term follow-up study of patients with adrenal incidentalomas. Eur. J. Endocrinol. 147, 489–494 (2002)CrossRefPubMedGoogle Scholar
  61. 61.
    M. Zeiger, G. Thompson, Q.-Y. Duh, A. Hamrahian, P. Angelos, D. Elaraj, E. Fishman, J. Kharlip, American Association of Clinical Endocrinologists, American Association of Endocrine Surgeons: American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas: Executive Summary of Recommendations. Endocr. Pract. 15, 450–453 (2009). CrossRefPubMedGoogle Scholar
  62. 62.
    M. Terzolo, A. Stigliano, I. Chiodini, P. Loli, L. Furlani, G. Arnaldi, G. Reimondo, A. Pia, V. Toscano, M. Zini, G. Borretta, E. Papini, P. Garofalo, B. Allolio, B. Dupas, F. Mantero, A. Tabarin, A.M.E. Position, Statement on adrenal incidentaloma. Eur. J. Endocrinol. 164, 851–870 (2011). CrossRefPubMedGoogle Scholar
  63. 63.
    S. Yamashita, K. Ito, K. Furushima, J. Fukushima, S. Kameyama, Y. Harihara, Laparoscopic versus open adrenalectomy for adrenal myelolipoma. Ann. Med. Surg. 3, 34–38 (2014). CrossRefGoogle Scholar
  64. 64.
    R. Chaudhary, A. Deshmukh, K. Singh, R. Biswas, Is size really a contraindication for laparoscopic resection of giant adrenal myelolipomas? BMJ. Case Rep. 2016, bcr2016215048 (2016). CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    A. Agrusa, G. Romano, G. Frazzetta, D. Chianetta, V. Sorce, G. Di Buono, G. Gulotta, Laparoscopic adrenalectomy for large adrenal masses: Single team experience. Int. J. Surg. 12, S72–S74 (2014). CrossRefPubMedGoogle Scholar
  66. 66.
    A.K. Hemal, A. Singh, N.P. Gupta, Whether adrenal mass more than 5 cm can pose problem in laparoscopic adrenalectomy? An evaluation of 22 patients. World J. Urol. 26, 505–508 (2008). CrossRefPubMedGoogle Scholar
  67. 67.
    X. Shen, Y. Qiu, Y. Zheng, S. Zhang, Retroperitoneal laparoscopic liposuction for large adrenal myelolipomas: A report of nine cases. J. Laparoendosc. Adv. Surg. Tech. 22, 578–580 (2012). CrossRefGoogle Scholar
  68. 68.
    Nakajo, M., Onohara, S., Shinmura, K., Fujiyoshi, F., Nakajo, M.: Embolization for spontaneous retroperitoneal hemorrhage from adrenal myelolipoma. Radiat. Med. 21, 214–219 (2003)Google Scholar
  69. 69.
    S.M. Chng, M.B.K. Lin, F.C. Ng, H.C. Chng, T.K. Khoo, Adrenal myelolipoma presenting with spontaneous retroperitoneal haemorrhage demonstrated on computed tomography and angiogram—a case report. Ann. Acad. Med. Singap. 31, 228–230 (2002)PubMedGoogle Scholar

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Authors and Affiliations

  1. 1.2nd Department of MedicineSemmelweis UniversityBudapestHungary
  2. 2.MTA-SE Molecular Medicine Research GroupHungarian Academy of Sciences and Semmelweis UniversityBudapestHungary

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