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A 53-year-old female patient with long-standing hypertension was evaluated for left flank pain. Abdominal CT scan revealed a 2,8 cm left adrenal mass. Metanephrine, normetanephrine and vanylmandelic acid levels in a 24-hour urine sample were increased. The levels of serum cortisol, renin, aldosteron, calcitonin, parathormone, calcium and phosphate were normal. Left adrenalectomy was performed. There was a nodular mass with a red cut surface in medullary region. The medulla was enlarged in other parts. On microscopic examination, the mass was composed of mature adipose tissue admixed with hematopoietic cells. The medulla was hyperplastic with a corticomedullary ratio of 1:5. After surgery, blood pressure and catecholamine levels normalized. Although myelolipomas are incidental findings, they can rarely present with endocrine dysfunction. In conclusion, surgical excision should be considered in adrenal incidentalomas with characteristic radiographic features of myelolipoma, presenting with biochemical abnormalities. [ABSTRACT FROM AUTHOR]