Combined Adrenal Myelolipoma and Pheochromocytoma

Abstract

A 39-year-old woman had a 2-year history of headache and hyperhidrosis. Magnetic resonance imaging showed 2 right adrenal tumors with different intensities (fig. 1). 131Metaiodobenzylguanidine scintigraphy revealed accumulation at the ventral tumor. Serum levels of norepinephrine were increased (579 pg.1 ml., normal 94 to 322). A %-hour urine sample revealed abnormally increased levels of dopamine (9,206 pg., normal 190 to 7401, norepinephrine (250 pg., normal 26 to 1211, epinephrine (312 pg., normal 3 to 15), normetanephrine (2.25 mglml., normal 0.04 to 0.18) and vanillylmandelic acid (11.2 mglml., normal 0.7 to 7.0). Adrenocorticotropic hormone, cortisol and aldosterone were normal (less than 60 pg./ml., 5.6 to 21.3 pg ld l . and 2 to 3 ng./dl., respectively). Based on these results right adrenal myelolipoma combined with pheochmmocytorna was suspected and surgical extirpation was performed. Pathological evaluation revealed that the ventral tumor was a 47 X 45 X 40 mm. 48 gm. pheochmmocytoma and the dorsal tumor was a 43 X 34 X 30 mm. 23 gm. myelolipoma (fig. 2). Quantitative analysis of