Abstract
Background: Adrenal myelolipoma (AML) is a nonfunctional benign neoplasm from the adrenal cortex, composed of mature fat and hematopoietic tissue. Usually, patients have no symptoms. However, some patients with hypertension and blood pressure normalize after AML surgery, indicating some connections between AML and hypertension.Materials and Methods: This was a retrospective cohort study of 369 patients diagnosed with AML from September 2008 to December 2018 collected in the Urology Department of West China Hospital, Chengdu, Sichuan, China. We collected clinical records of patients before surgery. Postoperative follow-up was also carried out for those with hypertension and whether patients needed to take antihypertensive drugs and postoperative blood pressure were recorded. We aim to explore the characteristics of both patients with AML having hypertension and having remission of hypertension in 1 year after surgery.Results: There were 369 patients with AML included in the study, 156 men and 213 women, aged 49.86 ± 11.61 years old. Among them, 121 (32.8%) patients presented with hypertension. Body mass index was significantly higher in the hypertension group than that in the nonhypertension group, even after adjusting other variables (26.26 ± 3.43 vs. 24.28 ± 3.38 kg/m2, P < 0.001 for both univariate and multivariate analyses). Sixty patients were followed up for 1–9 years, with a median follow-up of 52 months. The duration of hypertension in the remission group was shorter than that in the non-remission group (P = 0.020), and the tumor lateralization was significantly different between the two groups (P = 0.005).Conclusions: Nearly one-third of patients with AML suffered from hypertension in our study, and there existed some potential links between AML and hypertension. To be more specific, AML-related hypertension was more likely to result from obesity and renal compression by perirenal fat than from endocrine disorders or blood vessels compression. Patients with AML and with more than 3 years of hypertension might have less possibility to recover.
Highlights
Adrenal myelolipoma (AML) is generally considered a nonfunctional benign tumor originated from the adrenal cortex, made up of a variable proportion of mature fat and hematopoietic tissues [1]
The including criteria of this study were as follows: [1] neoplasm from adrenal presented by computer tomography (Figure 1); [2] adrenal incidentaloma more than 4 cm or complicated with hypertension or other symptoms; [3] patients who underwent surgical removal of adrenal neoplasm; and [4] diagnosis of AML confirmed by pathological examination after surgery (Figure 2)
Patients with AML were usually diagnosed at the age of 49.86 ± 11.61 on average, which is consistent with the report of Decmann A [5], who Number of cases (%) Mean age ± Standard deviation (SD), years Sex, males/females Mean body mass index (BMI) ± SD, kg/m2 Leading complaints (%) Median duration of hypertension, y Tumor location, left/right Mean tumor diameter ± SD, cm Mean plasma renin activity (PRA), ng/(ml·h) Mean plasma aldosterone concentration (PAC), ng/dl Suspicious primary aldosteronism (PA)* Suspicious Secondary aldosteronism (SA)* PA and SA negative*
Summary
Adrenal myelolipoma (AML) is generally considered a nonfunctional benign tumor originated from the adrenal cortex, made up of a variable proportion of mature fat and hematopoietic tissues [1]. Some patients are present with hypertension and are eventually diagnosed as AML by histopathological biopsy. There have been several reports on the normalized blood pressure following surgery of AML resection, suggesting that there may be a relationship between hypertension and AML [5,6,7,8]. Adrenal myelolipoma (AML) is a nonfunctional benign neoplasm from the adrenal cortex, composed of mature fat and hematopoietic tissue. Some patients with hypertension and blood pressure normalize after AML surgery, indicating some connections between AML and hypertension
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