OBJECTIVES: We report one case of adrenal myelolipoma in a female patient presenting with right lumbar pain over six months. METHODS: Diagnostic work included ultrasound, intravenous urography (IVU) and CT scan. RESULTS: The patient underwent right adenomectomy with the working diagnosis of adrenal myelolipoma. We describe the pathology report. CONCLUSIONS: Myelolipoma may present hematopoietic, fat and bone components. It continues being an incidental finding. Ultrasound and CT scan are effective diagnostic tests. Asymptomatic small tumors, smaller than 4 cm, may be monitored with watchful waiting. Symptomatic tumors greater than 4 cm should be extirpated because of the risk of spontaneous rupture with retroperitoneal bleeding. Bilateral adrenalectomy for big tumors implies medical replacement with hydrocortisone.