TY - JOUR
T1 - Clinical course of adrenal myelolipoma
T2 - A long-term longitudinal follow-up study
AU - Hamidi, Oksana
AU - Raman, Ram
AU - Lazik, Natalia
AU - Iniguez-Ariza, Nicole
AU - McKenzie, Travis J.
AU - Lyden, Melanie L.
AU - Thompson, Geoffrey B.
AU - Dy, Benzon M.
AU - Young, William F.
AU - Bancos, Irina
N1 - Publisher Copyright:
© 2020 John Wiley & Sons Ltd
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Objective: We aimed to describe clinical course of myelolipoma and to identify predictors of tumour growth and need for surgery. Design: A retrospective study. Patients: Consecutive patients with myelolipoma. Results: A total of 321 myelolipomas (median size, 2.3 cm) were diagnosed in 305 patients at median age of 63 years (range, 25-87). Median follow-up was 54 months. Most myelolipomas were incidentally detected (86%), whereas 9% were discovered during cancer staging and 5% during workup of mass effect symptoms. Thirty-seven (12%) patients underwent adrenalectomy. Compared to myelolipomas <6 cm, tumours ≥6 cm were more likely to be bilateral (21% vs 3%, P <.0001), cause mass effect symptoms (32% vs 0%, P <.0001), have haemorrhagic changes (14% vs 1%, P <.0001) and undergo adrenalectomy (52% vs 5%, P <.0001). Among patients with ≥6 months of imaging follow-up, median size change was 0 mm (−10, 115) and median growth rate was 0 mm/y (−6, 14). Compared to <1 cm growth, ≥1 cm growth correlated with larger initial size (3.6 vs 2.3 cm, P =.02), haemorrhagic changes (12% vs 2%, P =.007) and adrenalectomy (35% vs 8%, P <.0001). Conclusions: Most myelolipomas are incidentally discovered on cross-sectional imaging. Myelolipomas ≥6 are more likely to cause mass effect symptoms, have haemorrhagic changes and undergo resection. Tumour growth ≥1 cm is associated with larger myelolipoma and haemorrhagic changes. Adrenalectomy should be considered in symptomatic patients with large tumours and when there is evidence of haemorrhage or tumour growth.
AB - Objective: We aimed to describe clinical course of myelolipoma and to identify predictors of tumour growth and need for surgery. Design: A retrospective study. Patients: Consecutive patients with myelolipoma. Results: A total of 321 myelolipomas (median size, 2.3 cm) were diagnosed in 305 patients at median age of 63 years (range, 25-87). Median follow-up was 54 months. Most myelolipomas were incidentally detected (86%), whereas 9% were discovered during cancer staging and 5% during workup of mass effect symptoms. Thirty-seven (12%) patients underwent adrenalectomy. Compared to myelolipomas <6 cm, tumours ≥6 cm were more likely to be bilateral (21% vs 3%, P <.0001), cause mass effect symptoms (32% vs 0%, P <.0001), have haemorrhagic changes (14% vs 1%, P <.0001) and undergo adrenalectomy (52% vs 5%, P <.0001). Among patients with ≥6 months of imaging follow-up, median size change was 0 mm (−10, 115) and median growth rate was 0 mm/y (−6, 14). Compared to <1 cm growth, ≥1 cm growth correlated with larger initial size (3.6 vs 2.3 cm, P =.02), haemorrhagic changes (12% vs 2%, P =.007) and adrenalectomy (35% vs 8%, P <.0001). Conclusions: Most myelolipomas are incidentally discovered on cross-sectional imaging. Myelolipomas ≥6 are more likely to cause mass effect symptoms, have haemorrhagic changes and undergo resection. Tumour growth ≥1 cm is associated with larger myelolipoma and haemorrhagic changes. Adrenalectomy should be considered in symptomatic patients with large tumours and when there is evidence of haemorrhage or tumour growth.
KW - adrenal adenoma
KW - adrenal function
KW - adrenal incidentaloma
KW - adrenal mass
KW - adrenal tumour
KW - adrenalectomy
KW - congenital adrenal hyperplasia
KW - lipomatous adrenal tumours
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U2 - 10.1111/cen.14188
DO - 10.1111/cen.14188
M3 - Article
C2 - 32275787
AN - SCOPUS:85083859606
SN - 0300-0664
VL - 93
SP - 11
EP - 18
JO - Clinical Endocrinology
JF - Clinical Endocrinology
IS - 1
ER -