A distinct and uncommon clinical scenario arises when adrenal myelolipoma occurs alongside concomitant adrenal hormone excess. In these rare cases, the presence of hormone excess — rather than the myelolipoma itself — becomes the primary driver of management decisions.
In very rare situations of diagnosed adrenal hormone excess, management should be targeted to the type and site of adrenal hormone excess, which could be ipsilateral or contralateral to the myelolipoma. Accurate localisation is therefore a key step in determining the appropriate course of action.
Treatment is directed by both the type of hormone excess identified and its anatomical relationship to the myelolipoma — specifically whether the source is on the same or the opposite side. Surgical intervention is part of the approach in select anatomical configurations.
The complete structured protocol — including the full decision algorithm and all management steps — is available via the link below.
In very rare situations of diagnosed adrenal hormone excess, management should be targeted to the type and site of adrenal hormone excess, which could be ipsilateral or contralateral to the myelolipoma (figure 3).
Management is targeted to the type and site of adrenal hormone excess.
Adrenalectomy has also been the treatment of choice in patients with ipsilateral concomitant adrenal hormone excess.
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