From the Research
Myelolipoma is a benign tumor that can be managed conservatively if asymptomatic and small, but surgical removal is recommended for larger tumors or those causing symptoms, typically through laparoscopic adrenalectomy, as supported by the most recent study 1.
Diagnosis and Treatment
Myelolipomas are typically discovered incidentally during imaging studies performed for unrelated reasons, and most do not require treatment if they are small (less than 4-5 cm) and not causing symptoms.
- The decision for surgery should balance the risks of the procedure against the risk of complications from the tumor itself, such as hemorrhage or mass effect.
- Regular monitoring with imaging studies is appropriate for smaller, asymptomatic myelolipomas to ensure they remain stable in size.
- Laparoscopic adrenalectomy is a safe and feasible technique for surgical removal of myelolipomas, with reasonable operating time, limited blood loss, and short hospital stay, as reported in 2.
Prognosis and Follow-up
Myelolipomas have no malignant potential and do not secrete hormones, distinguishing them from other adrenal masses.
- The exact cause of myelolipomas remains unclear, though theories suggest they may develop from adrenal cortical cell metaplasia in response to stress, inflammation, or other stimuli.
- A long-term longitudinal follow-up study 1 found that most myelolipomas are incidentally discovered on cross-sectional imaging, and tumors ≥6 cm are more likely to cause mass effect symptoms, have hemorrhagic changes, and undergo resection.
Key Considerations
- Adrenalectomy should be considered in symptomatic patients with large tumors and when there is evidence of hemorrhage or tumor growth, as recommended in 1.
- The clinical course of myelolipoma can be unpredictable, and regular follow-up is necessary to monitor tumor size and detect any potential complications early.