Kienitz and colleagues describe the case of a patient with congenital adrenal hyperplasia (CAH) who was found to have bilateral adrenal lipomas. Whilst macronodular hyperplasia and unilateral myelolipomas are seen in people with CAH, this is thought to be the first report of rare adrenal lipomas being found bilaterally.

A 50-year-old man with well-controlled salt-wasting CAH presented with urinary urgency, and breathlessness on bending over. Abdominal imaging detected a 19cm right adrenal mass, and a 11cm mass in the left adrenal. The right-sided lesion was removed at laparotomy, and was found to consist almost entirely of capsulated mature adipose tissue, without histological evidence of malignancy. Although not resected, the left-sided mass had similar characteristics on imaging, and was thus thought also to be an adrenal lipoma.

The authors take the opportunity to discuss more widely the topic of adrenal masses in people with CAH. Routine adrenal imaging is not recommended. It is thought that adrenal myelolipomas might arise due to high adrenocorticotrophin levels, but the pathophysiology underlying adrenal lipomas is unknown.

Read the full article in Endocrinology, Diabetes & Metabolism Case Reports doi:10.1530/EDM-20-0204