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Large idiopathic unilateral adrenal hematoma in a young woman

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Abstract

This is a case report on a young woman with a large idiopathic unilateral adrenal hematoma (AH). Only few cases of AH which were not associated with any trauma, previous surgery, coagulative or any other systemic disorders have been described. The mass was discovered by abdominal ultrasound which was performed for a recent flank pain. Magnetic resonance imaging (MRI) confirmed the presence of a 13-cm sized lesion in the right hemi-abdomen; T1 and T2 weighed imaging was compatible with subacute-to-chronic adrenal hematoma. The lesion dislocated the liver and right kidney. Positron emission tomography (PET) did not show any significant radiotracer uptake by the mass. Serum cortisol, aldosterone, renin activity and DHEA-S were normal. Urinary catecholamines and free cortisol excretion were within the normal range too. The lesion was removed by transabdominal laparoscopic adrenalectomy without any complication. The histological exam confirmed a large subacute-to-chronic organized AH. In conclusion, in the absence of known risk factors, differential diagnosis of a large AH may not be easy. The possibility of an underlying pheochromocytoma, malignant adrenal or metastatic tumor must always be considered. In our patient, computed tomography (CT) scan and MRI suggested the presence of a large subacute-to-chronic AH, and PET excluded metabolic activity of the mass. Laparoscopic adrenalectomy can be the surgical treatment of choice in organized symptomatic AH. The correct diagnosis, early recognition and treatment of complications including adrenal insufficiency may decrease patient morbidity and mortality.

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References

  1. Vella A, Nippoldt TB, Morris JC 3rd. Adrenal hemorrhage: a 25-year experience at the Mayo Clinic. Mayo Clin Proc 2001, 76: 161–8.

    Article  PubMed  CAS  Google Scholar 

  2. Wilms G, Marchal G, Baert A, Adisoejoso B, Mangkuwerdojo S. CT and ultrasound features of post-traumatic adrenal hemorrhage. J Comput Assist Tomogr 1987, 11: 112–5.

    Article  PubMed  CAS  Google Scholar 

  3. Rana AI, Kenney PJ, Lockhart ME, et al. Adrenal gland hematomas in trauma patients. Radiology 2004, 230: 669–75.

    Article  PubMed  Google Scholar 

  4. Machuca Santa Cruz J, Julve Villalta E, Galacho Bech A, et al. Spontaneous retroperitoneal hematoma: our experience. Actas Urol Esp 1999, 23: 43–50.

    PubMed  CAS  Google Scholar 

  5. Di Rosa C, Venora S, Monterosso N, La Spada NM, Viola S. Retroperitoneal hematoma during heparin therapy. Comments on 3 cases. Minerva Chir 1997, 52: 493–7.

    PubMed  Google Scholar 

  6. Tauchmanova L, Rossi R, Coppola A, et al. Antiphospholipid syndrome, adrenal failure, dilated cardiomyopathy and chronic hepatitis: an unusual manifestation of multiorgan autoimmune injury? Europe J Endocrinol 1998, 139: 641–5.

    Article  CAS  Google Scholar 

  7. Beltran S, Mandassi R, Robert F, Remond A, Fournier A. Inaugural unilateral adrenal hematoma of an antiphospholipid syndrome. Presse Med 2004, 27: 385–8.

    Article  Google Scholar 

  8. Landron C, Paccalin M, Chameau AM, Bonnefoy M, Roblot P, Becq-Giraudon B. Adrenal haematoma in Henoch-Schoelnlei purpura. Rheumatology (Oxford) 2001, 40: 717–9.

    Article  CAS  Google Scholar 

  9. Gulla N, Patriti A, Capitanucci L, Fabbri B, Patriti A, Tristaino B. A case of “silent” pheochromocytoma presented as spontaneous retroperitoneal hematoma. Ann Ital Chir 2000, 71: 735–7.

    PubMed  CAS  Google Scholar 

  10. Amano T, Takemae K, Niikura S, Kuono M, Amano M. Retroperitoneal hemorrhage due to spontaneous rupture of adrenal myelolipoma. Int J Urol 1999, 6: 585–8.

    Article  PubMed  CAS  Google Scholar 

  11. Lee KW, Chon SB, Kim DY, et al. Adrenal cortical carcinoma initially presented with overhelming disseminated intravascular coagulation. Ann Hematol 2003, 82: 596–8.

    Article  PubMed  Google Scholar 

  12. Tape U, Kriisten F, Loffler A, Keller HW. Spontenous retroperitoneal hematoma in adrenal metastasis. Dtsch Med Wochenschr 1997, 122: 471–4.

    Article  Google Scholar 

  13. Kawashima A, Sandler CM, Ernst RD, et al. Imaging of non-traumatic hemorrhage of the adrenal gland. Radiographics 1999, 19: 949–63.

    Article  PubMed  CAS  Google Scholar 

  14. Chidiac RM, Aron DC. Incidentaloma. A disease of modern technology. Endocrinol Metab Clin North Am 1997, 26: 233–53.

    Article  PubMed  CAS  Google Scholar 

  15. Mantero F, Terzolo M, Arnaldi G, et al. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab 2000, 85: 637–44.

    PubMed  CAS  Google Scholar 

  16. Grumbach MM, Biller BM, Braunstein GD, et al. Management of clinically inapparent adrenal mass (“Incidentaloma”). Ann Int Med 2003, 138: 424–9.

    Article  PubMed  Google Scholar 

  17. Angeli A, Osella G, Ali A, Terzolo M. Adrenal incidentaloma: an overview of clinical and epidemiological data from the National Italian Study Group. Horm Res 1997, 47: 279–83.

    Article  PubMed  CAS  Google Scholar 

  18. Horne BD, Anderson JL, John JM, et al. for the International Heart Collaborative (IHC) Study Group. Which white blood cell subtype predict increased cardiovascular risk? J Am Coll Cardiol 2005, 45: 1638–43.

    Article  PubMed  Google Scholar 

  19. Avolio L, Fusillo M, Ferrari G, Chiara A, Bragheri R. Neonatal adrenal hemorrhage manifesting as acute scrotum: timely diagnosis prevents unnecessary surgery. Urology 2002, 59: 601–3.

    Article  PubMed  Google Scholar 

  20. Gabal Schehab L, Alagiri M. Traumatic adrenal injuries. J Urol 2005, 173: 1330–1.

    Article  Google Scholar 

  21. Hara F, Kishikawa T, Tomishige H, Nishikawa O, Nishida Y, Kongo M. A child with adrenocortical adenoma accompanied by congenital hemihypertrophy: report of a case. Surg Today 2000, 30: 861–5.

    Article  PubMed  CAS  Google Scholar 

  22. Miller W, Tyrrell JB. La ghiandola corticosurrenale. In: Felig P, Baxter JD and Frohman LA eds. Endocrinologia e Metabolismo. Milano McGraw-Hill. 1997: 499–639.

    Google Scholar 

  23. Kovacs KA, Lam YM, Pater JL. Bilateral massive adrenal hemorrhage. Assessment of putative risk factors by the casecontrol method. Medicine (Baltimore) 2001, 80: 45–53.

    Article  CAS  Google Scholar 

  24. Swift DL, Lingerman JE, Baum WC. Spontaneous retroperitoneal hemorrhage: a diagnostic challenge. J Urol 1980, 123: 577–82.

    PubMed  CAS  Google Scholar 

  25. Rao RH, Vagnucci AH, Amico JA. Bilateral massive adrenal hemorrhage: early recognition and treatment. Ann Intern Med 1989, 110: 227–35.

    Article  PubMed  CAS  Google Scholar 

  26. Rao RH. Bilateral massive adrenal hemorrhage. Med Clin North Am 1995, 79: 107–29.

    PubMed  CAS  Google Scholar 

  27. Barzon L, Boscaro M. Diagnosis and management of adrenal incidentalomas. J Urol 2000, 163: 398–407.

    Article  PubMed  CAS  Google Scholar 

  28. Tauchmanovà L, Colao A, Marzano LA, et al. Adrenocortical carcinoma: Twelve-year prospective experience. World J Surg 2004, 28: 896–903.

    Article  PubMed  Google Scholar 

  29. Kobayashi T, Iwai A, Takahashi R, Ide Y, Nishizawa K, Mitsumori K. Spontaneous rupture of adrenal pheochromocytoma: review and analysis of prognostic factors. J Surg Oncol 2005, 90: 31–5.

    Article  PubMed  Google Scholar 

  30. Hoeffel C, Legmann P, Luton JP, Chapuis Y, Fayet-Bonnin P. Spontaneous unilateral adrenal hemorrhage: computerized tomography and magnetic resonance imaging findings in 8 cases. J Urol 1995, 154: 1647–51.

    Article  PubMed  CAS  Google Scholar 

  31. Lerttumnongtum P, Muttarak M, Visrutaratna P, Ya-In C. Imaging features on unusual adrenal masses. Australas Radiol 2004, 48: 107–13.

    Article  PubMed  Google Scholar 

  32. Swift DL, Lingeman JE, Baum WC. Spontaneous retroperitoneal hemorrhage: a diagnostic challenge. J Urol 1980, 123: 577–82.

    PubMed  CAS  Google Scholar 

  33. Boland GW, Goldberg MA, Lee MJ, et al. Indeterminate adrenal mass in patients with cancer: evaluation at PET with 2-(F-18)-fluoro-2-deoxy-D-glucose. Radiology 1995, 194: 131–4.

    PubMed  CAS  Google Scholar 

  34. Rumley A, Emberson JR, Wannamethee SG, Lennon L, Whincup PH, Lowe GD. Effects of older age on firin D-dimer, C-reactive protein, and other hemostatic and inflammatory variables in men aged 60–79 years. J Thromb Haemost 2006, 4: 982–7.

    Article  PubMed  CAS  Google Scholar 

  35. Hoffman M, Blum A, Baruch R, Kaplan E, Benjamin M. Leucocytes and coronary heart disease. Atherosclerosis 2004, 172: 1–6.

    Article  PubMed  CAS  Google Scholar 

  36. Hendrickson RJ, Katzman PJ, Queiroz R, Sitzmann JV, Koniaris LG. Management of massive retroperitoneal hemorrhage from an adrenal tumor. Endocr J 2001, 48: 691–6.

    Article  PubMed  CAS  Google Scholar 

  37. Kobayashi T, Uenoayama S, Miura K, Takehara Y. Idiopathic unilateral adrenal hematoma: report of a case. Surg Today 2004, 34: 279–82.

    Article  PubMed  Google Scholar 

  38. Lal G, Duh QY. Laparoscopic adrenalectomy — indications and technique. Surg Oncol 2003, 12: 105–23.

    Article  PubMed  Google Scholar 

  39. Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing syndrome and pheochromocytoma. N Engl J Med 1992, 327: 1033.

    Article  PubMed  CAS  Google Scholar 

  40. Marzano LA, Musella M, Porcelli A, Marzano E, Guarino R. Minimally invasive adrenalectomy. In: Encyclopèdie Medico-Chirurgicale-I-41-496-2004.

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Authors and Affiliations

  1. Department of General and Endocrine Surgery, Federico II University of Naples, Naples, Italy

    L. A. Marzano, E. Marzano, R. Arienzo, R. Guarino & A. Porcelli

  2. Department of Molecular and Clinical Endocrinology and Oncology, “Federico II” University of Naples, Via S. Pansini 5, 80131, Naples, Italy

    L. Tauchmanova MD, PhD, G. Lombardi & R. Rossi

  3. Department of Anatomical Pathology and Cytology, Federico II University of Naples, Naples, Italy

    G. Ciancia

Authors
  1. L. A. Marzano
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  2. L. Tauchmanova MD, PhD
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  3. E. Marzano
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  4. R. Arienzo
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  5. R. Guarino
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  6. G. Ciancia
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  7. A. Porcelli
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  8. G. Lombardi
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  9. R. Rossi
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Corresponding author

Correspondence to L. Tauchmanova MD, PhD.

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Marzano, L.A., Tauchmanova, L., Marzano, E. et al. Large idiopathic unilateral adrenal hematoma in a young woman. J Endocrinol Invest 30, 52–58 (2007). https://doi.org/10.1007/BF03347396

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  • DOI: https://doi.org/10.1007/BF03347396

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