From the Guidelines
The management of adrenal myelolipomas should prioritize a conservative approach, with small, asymptomatic myelolipomas (less than 4 cm) requiring no further follow-up, as per the latest guidelines 1.
Key Considerations
- The latest study from 2023 1 provides the most up-to-date guidance on the management of adrenal myelolipomas.
- Myelolipomas are typically benign and composed of mature adipose tissue and hematopoietic elements, with an extremely low malignant potential.
- The size and symptoms of the myelolipoma should guide management decisions.
Management Approach
- Small, asymptomatic myelolipomas (less than 4 cm) do not require further follow-up imaging or functional testing, as stated in the 2023 guidelines 1.
- For myelolipomas between 4-7 cm, management decisions should be individualized based on patient factors and symptoms.
- Surgical intervention is recommended for myelolipomas that are symptomatic, larger than 7 cm, or showing rapid growth on serial imaging.
- The preferred surgical approach is laparoscopic adrenalectomy, which offers shorter hospital stays and faster recovery compared to open surgery.
Additional Recommendations
- Patients should be evaluated for hormonal activity before any intervention, though myelolipomas are typically non-functional.
- Pain management may be necessary for symptomatic cases using standard analgesics.
- The conservative approach for smaller lesions is justified by the benign nature of myelolipomas and their extremely low malignant potential.
- Patients should be reassured about the benign nature of these lesions while being monitored appropriately, with a focus on minimizing morbidity, mortality, and improving quality of life.
From the Research
Management of Adrenal Myelolipoma
The management of adrenal myelolipoma can be divided into several approaches, including:
- Watchful waiting for small asymptomatic tumors
- Surgical removal for symptomatic or large tumors
- Laparoscopic adrenalectomy as a preferred surgical method
Indications for Surgery
Surgery is indicated for:
- Symptomatic tumors
- Tumors larger than 4 cm
- Tumors with increased size on follow-up
- Atypical appearance on imaging
- Tumors causing acute clinical symptoms, such as intraperitoneal hemorrhage 2
Surgical Techniques
Several surgical techniques can be used, including:
- Open adrenalectomy
- Laparoscopic adrenalectomy
- Hand-assisted laparoscopic partial adrenalectomy
- Adrenal sparing surgery, which can be considered for appropriate removal of adrenal myelolipoma, even in giant adrenal myelolipoma 3
Postoperative Outcomes
Postoperative outcomes are generally favorable, with:
- Low morbidity and mortality rates
- Short hospital stay
- Quick recovery
- Alleviation of symptoms and emotional burden due to tumor presence 4, 2
Diagnostic Tools
Diagnostic tools, such as:
- Ultrasound (US)
- Computed tomography (CT)
- Magnetic resonance imaging (MRI)
- Fine needle aspiration (FNA) cytology under CT or US control, can be effective in diagnosing adrenal myelolipomas and avoiding unnecessary surgery 5