A rare case of non-functional adrenal myelolipoma associated with hypertension: a case report and literature review

Introduction: Adrenal myelolipomas (AMLs) are rare, benign tumors composed of adipose tissue and hematopoietic cells, including both myeloid and erythroid components. They account for approximately 0.08%–0.4% of all adrenal tumors and are more commonly diagnosed after the fifth decade of life. This case report is unique in that the AML was associated with hypertension despite normal catecholamine and aldosterone levels, a finding that has rarely been reported in the literature. Case presentation: A 58-year-old man with a 10-year history of well-controlled hypertension presented with nonspecific abdominal discomfort and mild pain. Magnetic resonance imaging of the abdomen revealed a well-defined, fat-containing lesion measuring 7.9 × 7.3 × 7.2 cm in the left suprarenal region, suggestive of AML or a fat-rich adenoma. Intraoperatively, an 8 × 7 cm left suprarenal mass with adhesions was identified and excised. At the 6-month follow-up, the patient’s blood pressure normalized despite discontinuation of antihypertensive medications, with no evidence of recurrence. Histopathology confirmed the diagnosis of a benign, non-functional AML. Discussion: In functional AMLs, hypertension results from secretion of catecholamines or aldosterone. However, hypertension may also occur in non-functional AMLs, likely due to compression of the renal parenchyma, a mechanism rarely reported in the literature. Conclusion: AML should be considered in the differential diagnosis of patients presenting with abdominal pain and concomitant hypertension. This case also helps clarify the indications for surgical intervention in AML, a decision that often remains challenging.