Aldosterone-secreting adrenal myelolipomas: Unveiling a rare etiology of resistant hypertension through clinical and surgical insights

This report presents the case of two patients with resistant hypertension due to aldosterone-secreting adrenal myelolipomas, both successfully treated with adrenalectomy. Case 1: A 50-year-old male with a 6-year history of uncontrolled hypertension and recent right abdominal pain was found to have a large right adrenal mass on imaging, suggestive of myelolipoma. Hormonal evaluation revealed elevated aldosterone levels with suppressed renin, indicating primary hyperaldosteronism. Post-adrenalectomy, histopathology confirmed the diagnosis of adrenal myelolipomas, and the patient experienced normalization of blood pressure, eventually discontinuing all antihypertensive medications. Case 2: A 43-year-old woman with resistant hypertension presented with a blood pressure of 240/120 mm Hg. Imaging showed a right adrenal mass. Hormonal studies confirmed hyperaldosteronism. Following adrenalectomy, histopathology confirmed myelolipoma, and her blood pressure normalized with a significant reduction in aldosterone levels. These cases emphasize the importance of recognizing aldosterone-secreting myelolipomas in patients with resistant hypertension, where early diagnosis and surgical treatment can result in marked clinical improvement.