Functioning adrenal myelolipoma: A rare cause of hypertension
A 40-year-old man referred to department of endocrinology with adrenal mass and hypertension. He was diagnosed with hypertension 3 years back, initial BP was 180/110 mm Hg, was started on anti-hypertensive treatment. On examination, there were no neurocutaneous markers or marfanoid habitus, no features of Cushing's syndrome, 24-hour urine metanephrines level was 3000 micrograms/day (normal < 900 micrograms/day, the test was done after stopping all interfering drugs). Ultrasonography revealed 9.8 × 8.5 cms well-defined predominantly hyperechoic lesion, faint hypoechogenicity originating from right suprarenal region abutting the upper pole of right kidney and lower surface of right lobe of liver suggestive of right adrenal mass. CECT of abdomen showed 9.8 × 8.5 cm well-defined, well-circumscribed heterogenous hypoattenuated mass lesion noted in right suprarenal region and minimal enhancement on contrast with −80 to −100 HF units of attenuation suggestive of myelolipoma of right adrenal gland []. Baseline hematological and biochemical investigations and urinalysis were normal. Low-dose dexamethasone suppression test was normal.\nIn view of hypertension, adrenal mass, and elevated 24-hour urine metanephrines (>3 times), possibility of pheochromocytoma was considered. Hypertension was brought under control. Patient underwent surgery, and well encapsulated right adrenal tumor (weight: 500 gm) was excised []. Biopsy of specimen was suggestive of adrenal myelolipoma []. Immuno-histochemistry of specimen revealed positive for chromogranin A, suggestive of catecholamine-secreting granules in the tissue [].\nThe patient had remission in hypertension. Metanephrine levels became normal after surgery. The patient is normal at the 3-month follow-up.