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 - Funding Information:
This research was supported by the James A. Ruppe Career Development Award in Endocrinology (IB) and the Catalyst Award for Advancing in Academics from Mayo Clinic (IB). This research was partly supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH) USA under award K23DK121888 (to I.B). The views expressed are those of the author(s) and not necessarily those of the National Institutes of Health USA.
Funding Information:
This research was supported by the James A. Ruppe Career Development Award in Endocrinology (IB) and the Catalyst Award for Advancing in Academics from Mayo Clinic (IB). This research was partly supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH) USA under award K23DK121888 (to I.B). The views expressed are those of the author(s) and not necessarily those of the National Institutes of Health USA.
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 -