Surgery is the mainstay of treatment of large adrenolipomas.

Surgery is the mainstay of treatment of large adrenolipomas.

• Management of adrenal myelolipoma is decided based upon the size of lesion and presence of symptoms.
• Small lesions measuring less than 5 cm, and those who are asymptomatic are usually monitored via imaging over a period of one to two years.
• Symptomatic tumors or myelolipomas larger than 7 cm should undergo elective surgical excision.
• The approach is based on the reported incidence of life-threatening emergencies caused by spontaneous rupture and hemorrhage within large lesions.
• Conventional or endoscopic access may be chosen according to the size of the tumor.
• Mini-invasive and endoscopic techniques are best utilized for smaller-sized lesions, depending on the expertise of the operator.
• Conventional methods including transabdominal, lumbar, subcostal or posterior access laparotomy operations have all been described in the literature.
• An extraperitoneal approach is preferable as it leads to quicker recovery of the patient and lesser postoperative complications.
• The midline approach is indicated for masses larger than 10 cm or in cases where there are adhesions and infiltration of the surrounding structures.
• Follow up is mandatory regardless of which surgical method has been employed.