Adrenal Myelolipoma in an 18-year-old Woman: A Case Report and Review of the Literature on Its Occurrence in Adolescents and Young Adults

Abstract

Background: Adrenal myelolipoma (AML) is an uncommon benign mesenchymal tumour composed of mature adipose tissue admixed with trilineage haematopoietic elements. It accounts for 3–5% of primary adrenal tumours and is typically diagnosed in the fifth to seventh decades of life; its occurrence in adolescents and young adults is exceptionally rare. Case Presentation: We report the case of an 18-year-old woman who presented with acute lithiasic cholangitis. Contrast-enhanced abdominal computed tomography, performed as part of the diagnostic work-up, incidentally revealed a well-circumscribed right adrenal mass measuring 53 × 38 × 41 mm with a predominant fat component (−90 Hounsfield units), highly suggestive of adrenal myelolipoma. Hormonal work-up, including measurement of plasma metanephrine and normetanephrine levels, yielded normal results. The patient underwent combined laparoscopic right adrenalectomy and cholecystectomy. Histopathological examination confirmed the diagnosis of adrenal myelolipoma without features of malignancy. The postoperative course was uneventful, and no recurrence or endocrine dysfunction was observed at follow-up. Conclusion: Although adrenal myelolipoma is exceptionally rare in adolescents and young adults, it should be included in the differential diagnosis of fat-containing adrenal masses in this age group. Multimodal imaging and systematic hormonal assessment are essential to confirm the diagnosis and exclude functioning adrenal tumours, while management should be individualised within a multidisciplinary setting.