Indian Journal of Endocrine Surgery and Research

Register      Login

VOLUME 18 , ISSUE 1 ( January-June, 2023 ) > List of Articles

ORIGINAL RESEARCH

Unilateral Adrenal Myelolipoma and Minimal Autonomous Cortisol Excess (MACE) with Disseminated Histoplasmosis: A Case Report

Ranjith Cheriyan Philip, Supriya Sen, Shawn Sam, Anish Jacob Cherian, MJ Paul

Keywords : Computed tomography, Disseminated histoplasmosis, Minimal autonomous cortisol excess, Unilateral adrenal myelolipoma

Citation Information : Philip RC, Sen S, Sam S, Cherian AJ, Paul M. Unilateral Adrenal Myelolipoma and Minimal Autonomous Cortisol Excess (MACE) with Disseminated Histoplasmosis: A Case Report. 2023; 18 (1):24-26.

DOI: 10.5005/jp-journals-10088-11206

License: CC BY-NC 4.0

Published Online: 30-06-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Background and aim: Adrenal myelolipoma is a benign tumor composed of both lipomatous and myeloid components. It is usually asymptomatic in presentation. Another spectrum may present with rupture and hemorrhage. Usually, myelolipoma are non-functional but an endocrine abnormality is seen in 7% of cases. Radiologically diagnosed and asymptomatic adrenal myelolipomas can be kept on follow-up. Symptomatic cases need adrenalectomy. Adrenal Histoplasmosis usually occurs as a part of disseminated histoplasmosis. This is a fungal infection which seen in both immunosuppressed and immunocompetent individuals. Here by reporting a patient presented with Unilateral adrenal myelolipoma with minimal autonomous cortisol excess (MACE) and disseminated histoplasmosis. Case description: This is a case report of a 64-year-old gentleman presented with vague abdominal discomfort and evaluation found to have large unilateral Adrenal myelolipoma with MACE. The patient underwent Laparoscopic adrenalectomy. Histopathological examination showed histoplasmosis, and was managed by antifungals. Conclusion: Symptomatic adrenal myelolipoma is managed by adrenalectomy. Prompt antifungal treatment has avoided complications of disseminated histoplasmosis. Clinical significance: This type of disseminated histoplasmosis in unilateral myelolipoma with MACE is a rare presentation and worth reporting.


HTML PDF Share
  1. Thota A, Shankar R, Desai M, et al. Adrenal myelolipoma: Controversies in its management. Indian J Urol 2015;31(2):94–101. DOI: 10.4103/0970-1591.152807.
  2. Ramirez M, Misra S. Adrenal myelolipoma: To operate or not? A case report and review of the literature. Int J Surg Case Rep 2014;5(8):494–496. DOI: 10.1016/j.ijscr.2014.04.001.
  3. Kauffman CA. Histoplasmosis: A clinical and laboratory update. Clin Microbiol Rev 2007;20(1):115–132. DOI: 10.1128/CMR.00027-06.
  4. Agrawal J, Bansal N, Arora A. Disseminated histoplasmosis in India presenting as Addisonian crisis with epiglottis involvement. ID Cases. 2020;21:e00844. DOI: 10.1016/j.idcr.2020.e00844.
  5. Wahab NA, Mohd R, Zainudin S, et al. Adrenal involvement in histoplasmosis. EXCLI J. 2013 Jan 11;12:1-4. PMID: 27047312.
  6. King-Yin Lam A. Lipomatous tumours in adrenal gland: WHO updates and clinical implications. Endocr Relat Cancer 2017;24(3):R65–R79. DOI: 10.1530/ERC-16-0564.
  7. Decmann Á, Perge P, Tóth M, et al. Adrenal myelolipoma: A comprehensive review. Endocrine 2018;59(1):7–15. DOI: 10.1007/s12020-017-1473-4.
  8. Khanna S, Priya R, Bhartiya S, et al. Adrenal tumors: An experience of 10 years in a single surgical unit. Indian J Cancer 2015;52(3):475–478. DOI: 10.4103/0019-509X.176749.
  9. Kothari D, Chopra S, Bhardwaj M, et al. Persistence of histoplasma in adrenals 7 years after antifungal therapy. Indian J Endocrinol Metab 2013;17(3):529–531. DOI: 10.4103/2230-8210.111679.
  10. Kumar S, Singh S. Unusual Presentations of Adrenal Masses. In: Lew JI, (Ed). Clinical Management of Adrenal Tumors. In Tech; 2017; DOI: 10.5772/intechopen.69393.
  11. Roxas MCA, Sandoval MAS, Salamat MS, et al. Bilateral adrenal histoplasmosis presenting as adrenal insufficiency in an immunocompetent host in the Philippines. BMJ Case Rep 2020;13(5):e234935. DOI: 10.1136/bcr-2020-234935.
  12. Hussain A, Cherian KE, Kapoor N, et al. Adrenal histoplasmosis – A therapeutic restoration of adrenal morphology. AACE Clin Case Rep 2022;8(1):45–46. DOI: 10.1016/j.aace.2021.03.006.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.