A77-yr-old man presented with rapidly progressive cer-ebellarsyndrome,extrapyramidalsigns,andcognitiveimpairment.Pastmedicalhistoryreportedaprostatecancertreated by external radiotherapy and an essential thrombo-cytemia with sideroblastic anemia. Brain computed tomog-raphy (CT) scan was normal. The combination of positiveantineutrophil antibodies and brain 18F-fluorodeoxyglu-cose (18F-FDG) positron emission tomography (PET) up-take pattern was suggestive of paraneoplastic neurologicalsyndrome. Whole-body PET imaging revealed bilateral hy-permetabolic adrenal masses (right and left adrenal maxi-mumstandardizeduptakevalue?11.4and8.0).AbdominalCTscanshowedbilateralheterogeneousadrenalmassescon-taining soft tissue and adipose components (Fig. 1). Com-plete endocrinological workup (24-h urinary free cortisol,low-dose dexamethasone suppression test, plasma aldoste-ronelevel,dehydroepiandrosteronesulfate,andurinaryandplasmamethoxyamines)wasnormal.ACTscan-guidedad-renalpuncturewasperformedtoruleoutmalignancy.Path-ological analyses were concordant with the diagnosis ofmyelolipoma.
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