From Trauma to Tumour: Incidental Giant Left Adrenal Myelolipoma in Congenital Adrenal Hyperplasia

Adrenal myelolipomas are rare, benign tumours composed of mature adipose and haematopoietic tissue.Patients with congenital adrenal hyperplasia (CAH) are predisposed to their development, with chronic adrenocorticotropic hormone (ACTH) hypersecretion secondary to impaired cortisol synthesis thought to be the principal driver of myelolipoma formation in this population.A 49-year-old female with known CAH presented to the emergency department following a stab wound to the abdomen.Computed tomography (CT) incidentally identified a 12 cm encapsulated left adrenal lesion consistent with a giant myelolipoma.Despite reported adherence to hydrocortisone and fludrocortisone replacement therapy, persistently elevated adrenal steroid precursors and plasma renin levels suggested suboptimal glucocorticoid control.Following multidisciplinary team (MDT) review, the patient was offered a left adrenalectomy given the lesion size (>10 cm) and concerns regarding the risk of spontaneous haemorrhage.This case underscores the importance of systematic imaging review beyond the primary indication for scanning, and the value of optimising biochemical monitoring and considering adrenal imaging in selected high-risk CAH patients.