Endocrine Abstracts

Introduction: Adrenal myelolipomas are benign and fatty tumors usually detected incidentally in imaging tests. Their prevalence increases in patients with CAH, probably because corticosteroid deficiency causes high ACTH levels that stimulate adrenal growth, although their effect on the growth of adrenal tumors is not yet well established.

Clinical case: A 41-year-old man with classic 21 OH deficiency, losing salt since he was 10 months old,with stable doses of corticosteroids for approximately 15 years, under follow-up in another center. He was referred to our hospital in June 2020 due to evidence of bilateral AI on spinal CT (requested for low back pain). In turn, he was referred to Urology who asked for an MRI that reported a heterogeneous solid mass of 11×9 cm in the left adrenal gland and a mass with similar characteristics measuring 7×4 cm in the right adrenal, the etiology of which was ‘undetermined’. Functionality was ruled out and finally, it was decided to perform a left adrenalectomy by laparoscopic in September 2020, with a pathological diagnosis of myelolipoma. The clinical committee, given the stable growth of the contralateral mass and similar imaging characteristics, decided to follow up with clinical and imaging tests.

Discussion: According to the literature, in our case, these tumors were diagnosed in the 5th decade of life and were bilateral. Although CAH is associated with the development of adrenal myelolipomas, screening using images is currently not recommended in affected patients. On the other hand, the Spanish Society of Endocrinology and Nutrition recommends to determine levels of 17-OHP in cases of bilateral AI.

Conclusion: In the context of following up on CAH, it is advisable to conduct both analytical and clinical monitoring. However, it should be noted that the progressive growth of the adrenal glands and the development of myelolipomas are currently not established as criteria for assessing undertreatment, despite their potential correlation.