2 R (a) (b) (c) Figure 1: Computed tomography of the adrenals in Patient 1. (a) Arrows show a 5.7 centimetre large, expansive process in the right adrenal with a heterogeneous stroma, fat, calciﬁcations, and in addition, pronounced bilateral adrenal hyperplasia. Magnetic resonance images of the adrenal tumor , T1 Weighted Imaging, with hyperintense fat (b) showing signal loss in fat suppressed image (c). myelolipoma (capsule, heterogeneous stroma, and fat in the adrenal mass) was found (Figure 1). Further investigation revealed height 164 cm, weight 76 kg, and blood pressure 120/80 mmHg. On palpation the Table 1: Myelolipoma: baseline measurements and endocrinologi- cal test results. 10 cm Baseline ACTH, pmol/L Cortisol, nmol/L 17 OH-progesterone, nmol/L DHEAS, µmol/L Androstendione, nmol/L Testosterone, nmol/L ACTH stimulation∗∗ Cortisol 30 minutes, nmol/L Cortisol 60 minutes, nmol/L 17 OH-progesterone 30 minutes, nmol/L 17 OH-progesterone 60 minutes, nmol/L Dexamethasone suppression∗∗∗ Cortisol, nmol/L 17 OH-progesterone, nmol/L Patient 1 6–32.8∗ 210 >605 14.4 43.8 11.7 211 231 >605 >605 22 14.3 Case Reports in Medicine Patient 2 Normal 10.9–94.2 (2–13) (250–750) (<6) (6–12) (<5.6) (10–40) (>550) (<30) (<50) 387 445 1.8 10.9 10.1 409 412 445 560 45 18.8 ∗ Most values in the higher range. ∗∗Corticotropin (250 ug i.v.). ∗∗∗1 mg overnight test in Patient 2 and 0.5 mg × 4 for 2 days in Patient 1. patient had no enlargement of the thyroid gland. Genital examination showed normal penile size and subnormal tes- ticular volume of 12 mL bilaterally. Biochemical investigation revealed low basal cortisol, which did not increase after ACTH stimulation (Table 1). He had a high basal level of 17-OH-progesterone, typical of 21-hydroxylase deﬁciency, which was suppressed after a conventional dexamethasone test (Table 1). DNA sequencing of the CYP21 (steroid 21- hydroxylase) gene revealed the c. 515T > A point mutation, which results in the predicted amino acid change I172N. The mutation was present in hemi- or homozygous form (i.e., the genotype was I 172N/deletion or I172N/I172N). The adrenal mass caused no symptoms and was considered highly likely benign and therefore left untreated. The tumor and hyperplasia did not change radiologically over a nine- year subsequent observation period. The patient continues to do well without steroid medication, but is instructed to take steroids during stress. 3. Case Report 2 A previously healthy 68-year-old man, father of one child, presented in 1994 with fatigue and nausea. For many years he had suﬀered arthralgic pain and had been treated with antiﬂogistics. The last months he had experienced problems with nocturia and impotence. He was referred