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Giant bilateral adrenal myelolipoma with congenital adrenal hyperplasia.
[congenital adrenal hyperplasia]
Myelolipomas
are
rare
and
benign
neoplasms
,
predominant
of
the
adrenal
glands
,
consisting
of
adipose
and
mature
hematopoietic
tissue
,
commonly
discovered
incidentally
with
increased
use
of
radiologic
imaging
.
Few
cases
of
giant
bilateral
adrenal
masses
are
reported
,
especially
in
the
setting
of
congenital
adrenal
hyperplasia
(
CAH
)
.
We
report
the
case
of
a
39
-
year
-old
male
with
a
history
of
CAH
secondary
to
21
-
α
hydroxylase
deficiency
on
steroids
since
childhood
,
self-discontinued
during
adolescence
,
presenting
with
abdominal
distension
,
fatigue
,
decreased
libido
,
and
easy
bruising
.
Imaging
revealed
giant
bilateral
adrenal
masses
.
He
subsequently
underwent
bilateral
adrenalectomy
found
to
be
myelolipomas
measuring
30
×
25
×
20
cm
on
the
left
and
weighing
4
.
1
kg
and
25
×
20
×
13
cm
on
the
right
and
weighing
2
.
7
kg
.
Adrenal
myelolipomas
are
found
to
coexist
with
many
other
conditions
such
as
Cushing
's
syndrome
,
Addison
's
disease
,
and
CAH
.
We
discuss
the
association
with
high
adrenocorticotropic
hormone
(
ACTH
)
states
and
review
the
studies
involving
ACTH
as
proponent
leading
to
myelolipomas
.
Massive
growth
of
these
tumors
,
as
in
our
case
,
can
produce
compression
and
hemorrhagic
symptoms
.
We
believe
it
is
possible
that
self-discontinuation
of
steroids
,
in
the
setting
of
CAH
,
may
have
resulted
in
the
growth
of
his
adrenal
masses
.
Diseases
Validation
Diseases presenting
"fatigue"
symptom
benign recurrent intrahepatic cholestasis
cholangiocarcinoma
congenital adrenal hyperplasia
cowden syndrome
cutaneous mastocytosis
dedifferentiated liposarcoma
dracunculiasis
erdheim-chester disease
esophageal carcinoma
fabry disease
familial hypocalciuric hypercalcemia
familial mediterranean fever
hydrocephalus with stenosis of the aqueduct of sylvius
inclusion body myositis
kabuki syndrome
lymphangioleiomyomatosis
neuralgic amyotrophy
pleomorphic liposarcoma
systemic capillary leak syndrome
triple a syndrome
typhoid
von hippel-lindau disease
waldenström macroglobulinemia
x-linked adrenoleukodystrophy
This symptom has already been validated