Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
Head of Department, Department of Surgical Discipline, All India Institute of Medical Sciences, New Delhi, India.
BMJ Case Rep. 2021 Jan 29;14(1):e239441. doi: 10.1136/bcr-2020-239441.
A 38-yearr-old man presented with erectile dysfunction and infertility. On examination, he was hypertensive and detected to have a left flank mass. Blood investigations were unremarkable except raised serum noradrenaline levels. Imaging revealed multiple well-defined fat-containing hypodense lesions in left suprarenal area with largest one measuring 14×16 cm, suggestive of left adrenal myelolipoma. Diagnostic dilemma was posed due to discordance between clinical, biochemical and imaging findings. Left adrenal mass resection was planned keeping the possibility of pheochromocytoma. However, histopathology revealed it to be adrenal myelolipoma. Hypertension was resolved in the postoperative period and serum noradrenaline levels were normalised. Final diagnosis of a secretary adrenal myelolipoma was made, which is an extremely rare entity.
一位 38 岁男性因勃起功能障碍和不育就诊。体格检查发现他患有高血压，并在左侧肋腹部触及一肿块。血液检查除血清去甲肾上腺素水平升高外无其他异常。影像学检查显示左肾上腺区多个边界清楚的含脂肪的低密度病灶，最大者约 14×16cm，提示左肾上腺髓样脂肪瘤。由于临床、生化和影像学表现不一致，诊断存在困难。考虑到嗜铬细胞瘤的可能性，计划进行左肾上腺肿块切除术。然而，组织病理学检查显示为肾上腺髓样脂肪瘤。术后高血压得到缓解，血清去甲肾上腺素水平恢复正常。最终诊断为罕见的分泌性肾上腺髓样脂肪瘤。
