Spontaneous Massive Adrenal Hemorrhage: A Management Dilemma

Abstract

Adrenal hemorrhage (AH) is a rare but life-threatening condition. Small focal hemorrhage may present subclinically, but massive hemorrhage may lead to rapid cardiovascular collapse and ultimately death if not diagnosed appropriately and treated quickly. Most cases reported in the literature have been treated conservatively. In an event of increasing hemorrhage during conservative management, it may be tricky to intervene surgically because of the hematoma around the gland. Here we describe a case where we managed a large spontaneous AH by a combination of angioembolization and laparoscopic adrenalectomy.

Retroperitoneal hematoma by different causes: Presentation of two emergency cases at computed tomography

“…Such hematomas vary in size from a few centimeters to more than 10cm. On CT, they are characterized as circular masses with no contrast enhancement and attenuation greater than that of the liquids similar [12 , 13] . When there is suspicion of adrenal disease in a patient with retroperitoneal hemorrhage, hemodynamic monitoring, preferably in an intensive care unit, is recommended.…”

Rivaroxaban Related Bilateral Adrenal Hemorrhage: A Rare Complications of Direct Oral Anticoagulants – A Case Reports

“…Some case reports have been reported showing increased bleeding risk with concurrent use of novel oral anticoagulants (NOACs) with amiodarone, fluconazole, rifampin, and phenytoin. But our patient was not taking any medications which can lead to drug interaction [11–13].…”

“…Patients who respond to blood transfusions and stress dose steroids do not usually require surgical intervention. If a patient is hemodynamically stable, surgery should be avoided but the patient should be monitored closely [11].…”

Acute spontaneous unilateral adrenal hemorrhage: etiology and imaging findings in six cases

“…When there is suspicion of adrenal disease in a patient with retroperitoneal hemorrhage, hemodynamic monitoring, preferably in an intensive care unit, is recommended ( 23 ) . In patients with active bleeding, angiographic embolization is a valuable tool to achieve hemostasis.…”

“…If the patient remains hemodynamically stable and asymptomatic after embolization, immediate surgical exploration is not necessary. However, if the condition of the patient deteriorates, surgical options should be considered ( 23 ) .…”