Adrenal
myelolipoma is a benign metaplastic collection of reticuloendothelial cells and adipose tissue, believed to be secondary to chronic stimulation of the adrenals.
Keratoconus is the most common corneal
ectasia of unknown pathogenesis. Altered expression of
proteinases,
proteinases inhibitors, and
cytokines are believed to have a role. We report for the first time, the occurrence of adrenal
myelolipoma in a 52-year-old man with bilateral
keratoconus with right corneal
scarring for 13 years, who had presented with
abdominal pain and heaviness for 4 weeks. Computerized tomography abdomen revealed 7.4 × 7.0 × 6.6 cm hypo-dense variegated left adrenal mass [-71 to -51 Hounsfield Unit (HU)] with smooth borders and poor contrast uptake, suggestive of adrenal
myelolipoma, which was biochemically non-functional in view of normal overnight
dexamethasone suppressed
cortisol (1.4 mcg/dl), 24 h urinary fractionated metanephrines [metanephrines 57 mcg/day (53-341); normetanephrines 95 mcg/day (88-444)],
androgen levels [dehydroepiandrostenedione-sulphate 112 mcg/dl (21-123);
testosterone 542 ng/dl (275-1200)] with normal visualization of the contralateral adrenal. The cause of this association could not be determined. However, it may be hypothesized that altered adrenal
steroid metabolism may have some role in the development of
myelolipoma in our patient with
keratoconus; in view of increased occurrence of
myelolipoma in patients with
congenital adrenal hyperplasia (CAH), isolated report of
keratoconus in twins with CAH and mice model of
keratoconus demonstrating the role of
androgens in the development of
keratoconus.