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Rzepka E, Kokoszka J, Grochowska A, Ulatowska-Białas M, Lech M, Opalińska M, Przybylik-Mazurek E, Gilis-Januszewska A, Hubalewska-Dydejczyk A. Adrenal bleeding due to pheochromocytoma - A call for algorithm. Front Endocrinol (Lausanne) 2022; 13:908967. [PMID: 35992110 PMCID: PMC9389316 DOI: 10.3389/fendo.2022.908967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/05/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Adrenal hemorrhage is a rare, usually life-threating complication. The most common neoplasm resulting in spontaneous adrenal bleeding is pheochromocytoma and it accounts for nearly 50% of cases. Currently, the recommendations for the diagnosis and management of patients with adrenal bleeding due to pheochromocytoma are unavailable. MATERIALS AND METHODS We performed a database search for all pheochromocytoma patients, diagnosed and treated from 2005 to 2021 in tertiary endocrinology center. 206 patients were identified, 183 with complete data were included in the analysis. We investigated clinicopathological characteristics, treatment and outcomes of hemorrhagic pheochromocytoma cases and characterize our approach to perioperative diagnosis and medical management. Finally our experiences and data from previously published articles concerning adrenal hemorrhage were analyzed to propose a diagnostic and therapeutic algorithm for hemorrhagic pheochromocytomas. RESULTS In the whole group, seven patients (4 men and 3 women) with adrenal bleeding were found, (3.8%). Median patient's age was 49 years (range: 36-78 years). The most common manifestation of adrenal bleeding was acute abdominal pain (5/7). Two patients developed shock. Hormonal assessment was performed in five patients, based on 24-hour urinary fractionated metanephrines with urinary 3-methoxytyramine. Normetanephrine was elevated in all patients, metanephrine and 3-methoxytyramine - in four cases (4/5). Most patients (6/7) had symptoms suggesting pheochromocytoma before hemorrhage - most commonly paroxysmal hypertension (4/7). One patient died, before the diagnosis of adrenal bleeding was made. Diagnostic imaging performed in six out of seven patients revealed adrenal tumor, with median largest diameter equal to 7.4 cm (range: 5-11 cm). Five patients had elective surgery, in one case an urgent surgery was performed. In all cases the diagnosis of pheochromocytoma was confirmed in postoperative histopathology or in autopsy. The perioperative survival rate was 85.7%. CONCLUSIONS Diagnosis of pheochromocytoma should be always considered in patients with adrenal bleeding, especially with accompanying abdominal pain, hemodynamic shock and previous history of pheochromocytoma-associated symptoms. Lack of proper diagnosis of pheochromocytoma before surgery is associated with an additional perioperative risk. To improve the decision making in this life-threatening clinical situation, based on our results and literature data, we proposed a diagnostic and treatment algorithm.
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Affiliation(s)
- Ewelina Rzepka
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Cracow, Poland
| | - Joanna Kokoszka
- Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, Cracow, Poland
| | - Anna Grochowska
- Department of Radiology, University Hospital, Cracow, Poland
| | | | - Martyna Lech
- Department of Pathomorphology, Jagiellonian University Medical College, Cracow, Poland
| | - Marta Opalińska
- Nuclear Medicine Unit, Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, Cracow, Poland
| | | | - Aleksandra Gilis-Januszewska
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Cracow, Poland
- *Correspondence: Aleksandra Gilis-Januszewska,
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Rebollo-Román A, Alhambra-Expósito MR, Herrera-Martínez Y, Leiva-Cepas F, Alzas C, Muñoz-Jiménez C, Ortega-Salas R, Molina-Puertas MJ, Gálvez-Moreno MA, Herrera-Martínez AD. Catecholaminergic Crisis After a Bleeding Complication of COVID-19 Infection: A Case Report. Front Endocrinol (Lausanne) 2021; 12:693004. [PMID: 34566886 PMCID: PMC8456100 DOI: 10.3389/fendo.2021.693004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/04/2021] [Indexed: 12/30/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents in some cases with hemostatic and thrombotic complications. Pheochromocytomas are unusual, though potentially lethal tumors. Herein we describe the first case of hemorrhage in a pheochromocytoma related to SARS-CoV-2 infection. A 62-year-old man consulted for syncope, fever, and palpitations. He was diagnosed with SARS-CoV-2 pneumonia and presented with a hemorrhage in a previously unknown adrenal mass, which resulted in a catecholaminergic crisis. Medical treatment and surgery were required for symptom control and stabilization. We hereby alert clinicians to watch for additional/unreported clinical manifestations in COVID-19 infection.
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Affiliation(s)
- Angel Rebollo-Román
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, Córdoba, Spain
- Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain
| | - Maria R. Alhambra-Expósito
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, Córdoba, Spain
- Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain
| | | | - F. Leiva-Cepas
- Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain
- Pathology Service, Reina Sofia University Hospital, Córdoba, Spain
| | - Carlos Alzas
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, Córdoba, Spain
| | - Concepcion Muñoz-Jiménez
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, Córdoba, Spain
- Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain
| | - R. Ortega-Salas
- Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain
- Pathology Service, Reina Sofia University Hospital, Córdoba, Spain
| | - María J. Molina-Puertas
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, Córdoba, Spain
- Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain
| | - Maria A. Gálvez-Moreno
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, Córdoba, Spain
- Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain
- *Correspondence: Aura D. Herrera-Martínez, ; Maria A. Gálvez-Moreno,
| | - Aura D. Herrera-Martínez
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, Córdoba, Spain
- Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain
- *Correspondence: Aura D. Herrera-Martínez, ; Maria A. Gálvez-Moreno,
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3
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Elmoheen A, Yousry M, Elmesery A, Bashir K. Ruptured functioning adrenal tumour, atypical presentation with renal colic and hypertension. BMJ Case Rep 2020; 13:13/12/e236050. [PMID: 33334743 PMCID: PMC7747614 DOI: 10.1136/bcr-2020-236050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Pheochromocytomas are uncommon tumours that originate in chromaffin cells. They are a representation of 0.1%–1% of all cases of secondary hypertension. Most pheochromocytomas are unilateral and benign, featuring catecholamine production, as well as the production of other neuropeptides. Pheochromocytomas are mostly located in the adrenal gland; the frequency of occurrence is highest between 30 and 50 years of age; however, up to 25% of cases may be linked to multiple endocrine neoplasia type 2, Von-Hippel-Landau disease and type 1 neurofibromatosis in the young. We present a case of ruptured left adrenal pheochromocytoma with an atypical presentation. A 30-year-old male patient presented with severe left flank pain and hypertension. The CT scan of the abdomen showed bleeding from the left adrenal mass, where resuscitation and angioembolisation were done. Embolisation of the inferior and superior arteries was done, but the middle failed. The patient experienced a significant drop in haemoglobin and a haemorrhagic shock post angioembolisation, which called for emergency laparotomy. The patient is currently doing well with an uneventful postoperative course.
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Affiliation(s)
- Amr Elmoheen
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Yousry
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Elmesery
- Radiology Department, Sultan Qaboos Hospital, Salalah, Oman
| | - Khalid Bashir
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
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4
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Spontaneous Adrenal Hemorrhage—a Mixed Bag: 18 Cases from a Single Institution. Indian J Surg 2020. [DOI: 10.1007/s12262-019-01969-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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5
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Kabeel K, Marjara J, Bhat R, Gaballah AH, Abdelaziz A, Bhat AP. Spontaneous hemorrhage of an adrenal myelolipoma treated with transarterial embolization: A case report. Radiol Case Rep 2020; 15:961-965. [PMID: 32419895 PMCID: PMC7214766 DOI: 10.1016/j.radcr.2020.04.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 01/14/2023] Open
Abstract
Adrenal myelolipoma is a benign tumor of the adrenal cortex composed predominantly of fat and hematopoietic tissue. These lesions are usually asymptomatic, and most often incidentally detected on imaging. Uncommonly, they present with retroperitoneal hemorrhage, and these have been traditionally treated with emergent surgery. Although, transarterial embolization has been effectively and safely used in patients presenting with active hemorrhage from acute traumatic and nontraumatic causes, literature specifically pertaining to adrenal artery embolization is scant, perhaps due to smaller size and variability of adrenal arteries. With recent advances in endovascular techniques and imaging, there are emerging case reports and series of adrenal artery embolization in acute and nonacute settings. We report a case of spontaneous hemorrhage within an adrenal myelolipoma in a 43-year-old male patient, successfully treated with transarterial embolization, thereby avoiding major surgery. Our report adds to the growing body of literature pertaining to adrenal artery embolization.
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Affiliation(s)
- Khalid Kabeel
- Department of Radiology, Body Imaging Section, University of Missouri, Columbia, MO 65212, USA
| | - Jasraj Marjara
- University of Missouri-Columbia School of Medicine, Columbia, MO 65212, USA
| | - Roopa Bhat
- Department of Radiology, Body Imaging Section, University of Missouri, Columbia, MO 65212, USA
| | - Ayman H Gaballah
- Department of Radiology, Body Imaging Section, University of Missouri, Columbia, MO 65212, USA
| | - Amr Abdelaziz
- Department of Radiology, Body Imaging Section, University of Missouri, Columbia, MO 65212, USA
| | - Ambarish P Bhat
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Missouri, One Hospital Drive, Columbia, MO 65212, USA
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6
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Giurazza F, Corvino F, Silvestre M, Cangiano G, Cavaglià E, Amodio F, De Magistris G, Frauenfelder G, Niola R. Adrenal glands hemorrhages: embolization in acute setting. Gland Surg 2019; 8:115-122. [PMID: 31183321 DOI: 10.21037/gs.2018.10.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Acute adrenal hemorrhages are a rare event compared to other abdominal visceral injuries because of the anatomic localization of the adrenal glands; main causes are trauma and ruptured neoplasms. This manuscript reports on a single center experience of transarterial embolizations of adrenal hemorrhages in emergency setting. Methods In this retrospective analysis from 2010 to date, 17 patients (12 men and 5 women, mean age: 59.8 years) presenting with adrenal bleedings were treated by endovascular embolization. The etiology was traumatic in 7 cases, ruptured neoplasm in 8 cases and spontaneous in 2 patients assuming oral anticoagulant therapy. After thin slice contrast enhanced CT, a superselective embolization was conducted with different embolizing agents according to the type of vessel lesion and operator preference. Results Technical success rate, considered as interruption of adrenal bleeding detectable at angiography, was 94.1%. Clinical success rate, considered as hemodynamic stability restoration within 24 hours from the procedure, was 82.3%. Vessels involved were the superior adrenal artery in 5 patients, the middle adrenal artery in 8 patients, the inferior adrenal artery in one patient and more than one adrenal artery in 3 patients. No procedure-related major complications occurred and no patients had infarctions, necrosis, abscess formation, or required long-term steroid supplementation. Conclusions Acute adrenal hemorrhages can be safely and effectively managed by catheter directed embolizations; the source of bleeding has to be carefully investigated at CT and angiography because adrenal glands present with a wide and complex vascular arterial network.
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Affiliation(s)
- Francesco Giurazza
- Interventional Radiology Department, Cardarelli Hospital of Naples, Naples, Italy
| | - Fabio Corvino
- Interventional Radiology Department, Cardarelli Hospital of Naples, Naples, Italy
| | - Mattia Silvestre
- Interventional Radiology Department, Cardarelli Hospital of Naples, Naples, Italy
| | - Gianluca Cangiano
- Interventional Radiology Department, Cardarelli Hospital of Naples, Naples, Italy
| | - Errico Cavaglià
- Interventional Radiology Department, Cardarelli Hospital of Naples, Naples, Italy
| | - Francesco Amodio
- Interventional Radiology Department, Cardarelli Hospital of Naples, Naples, Italy
| | | | | | - Raffella Niola
- Interventional Radiology Department, Cardarelli Hospital of Naples, Naples, Italy
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7
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Edo N, Yamamoto T, Takahashi S, Mashimo Y, Morita K, Saito K, Kondo H, Sasajima Y, Kondo F, Okinaga H, Tsukamoto K, Ishikawa T. Optimizing Hemodynamics with Transcatheter Arterial Embolization in Adrenal Pheochromocytoma Rupture. Intern Med 2018; 57:1873-1878. [PMID: 29491290 PMCID: PMC6064710 DOI: 10.2169/internalmedicine.9907-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Pheochromocytoma rupture is rare, and emergent adrenalectomy is associated with a high mortality. We herein report a patient with pheochromocytoma rupture who was stabilized by transcatheter arterial embolization (TAE) and subsequently underwent elective surgery. A 45-year-old man presented with the sudden onset of left lateral abdominal pain, headache, chest discomfort, high blood pressure, and adrenal hemorrhaging on enhanced abdominal computed tomography. TAE was performed under a provisional diagnosis of pheochromocytoma rupture. Following oral doxazosin, he underwent elective left adrenalectomy four and a half months after TAE. Stabilizing the hemodynamic status by TAE before adrenalectomy is a viable option for treating pheochromocytoma rupture.
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Affiliation(s)
- Naoki Edo
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Takahiro Yamamoto
- Department of Radiology, Teikyo University School of Medicine, Japan
| | - Satoshi Takahashi
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Yamato Mashimo
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Koji Morita
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Koji Saito
- Department of Pathology, Teikyo University School of Medicine, Japan
| | - Hiroshi Kondo
- Department of Radiology, Teikyo University School of Medicine, Japan
| | - Yuko Sasajima
- Department of Pathology, Teikyo University School of Medicine, Japan
| | - Fukuo Kondo
- Department of Pathology, Teikyo University School of Medicine, Japan
| | - Hiroko Okinaga
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Kazuhisa Tsukamoto
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
| | - Toshio Ishikawa
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
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8
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Ierardi AM, Petrillo M, Patella F, Biondetti P, Fumarola EM, Angileri SA, Pesapane F, Pinto A, Dionigi G, Carrafiello G. Interventional radiology of the adrenal glands: current status. Gland Surg 2018; 7:147-165. [PMID: 29770310 DOI: 10.21037/gs.2018.01.04] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
As more and more adrenal neoplasms are found incidentally or symptomatically, the need for interventional procedures has being increasing. In recent years these procedures registered continued steady expansion. Interventional radiology of the adrenal glands comprises angiographic and percutaneous procedures. They may be applied both in benign and in malignant pathologies. The present review reports the current status of indications, techniques results and complications of the image-guided procedures.
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Affiliation(s)
- Anna Maria Ierardi
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Mario Petrillo
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Francesca Patella
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Pierpaolo Biondetti
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Enrico Maria Fumarola
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | | | - Filippo Pesapane
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Antonio Pinto
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | - Gianlorenzo Dionigi
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital, Policlinico "G. Martino", University of Messina, Messina, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
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9
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Saran JS, Moalem J, Schoeniger L, Tzimas K. Perioperative Management of Pheochromocytoma Resection in a Patient With Severe Aortic Stenosis. J Cardiothorac Vasc Anesth 2017; 32:2712-2715. [PMID: 29276086 DOI: 10.1053/j.jvca.2017.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Jagroop Singh Saran
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | - Jacob Moalem
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Luke Schoeniger
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Konstantine Tzimas
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
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10
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Jee YS. Spontaneous ruptured pheochromocytoma: an unusual case report and literature review. Ann Surg Treat Res 2017; 93:170-172. [PMID: 28932734 PMCID: PMC5597542 DOI: 10.4174/astr.2017.93.3.170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/22/2017] [Accepted: 02/07/2017] [Indexed: 11/30/2022] Open
Abstract
Ruptured pheochromocytoma is a rare disease. Its mortality rate is up to 31%–50%. Proper management of ruptured pheochromocytoma remains unclear. A 44-year-old male patient visited our Emergency Department and presented with abrupt onset of left flank pain. His blood pressure was 190/140 mmHg with purse rate of 130 beats/min. CT scan showed 8.1 × 5.6-cm-sized heterogeneously mass with rupture on the left retroperitoneal space and active bleeding. His symptom of abdominal pain was aggravated. Follow-up laboratory analysis revealed elevated WBC count and decreased hemoglobin 2 hours after admission. Emergency laparotomy was performed. We resected the ruptured left retroperitoneal mass and hemostasis. Pathologic exams revealed adrenal pheochromocytoma with rupture. Although our patient was alive, according to literature review, mortality rate of emergency operation without medical management is higher than elective operation after blood pressure control with either medical or interventional methods such as transcatheter arterial embolization.
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Affiliation(s)
- Ye Seob Jee
- Department of Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
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11
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Souiki T, Tekni Z, Laachach H, Bennani A, Zrihni Y, Tadmori A, Ajdi F, Bouazzaoui A, Chbani L, Akoudad H, Mazaz K, Aitlaalim S. Catastrophic hemorrhage of adrenal pheochromocytoma following thrombolysis for acute myocardial infarction: case report and literature review. World J Emerg Surg 2014; 9:50. [PMID: 25276225 PMCID: PMC4177258 DOI: 10.1186/1749-7922-9-50] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 09/11/2014] [Indexed: 11/13/2022] Open
Abstract
We describe here the case of a 62-year-old man with acute abdominal syndrome and severe hemorrhagic shock following successful thrombolysis for acute cardiac infarction. Emergency surgical exploration revealed extensive intraperitoneal and retroperitoneal hemorrhage resulting from the rupture of a large adrenal tumor. The diagnosis of pheochromocytoma was confirmed by histological findings. The patient died a few hours after surgery from multiorgan failure despite resuscitation attempts. This report discusses the diagnosis difficulties, treatment approach, and relevant literature.
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Affiliation(s)
- Tarik Souiki
- School of medicine and pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco ; Department of surgery, University Hospital Hassan II, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco
| | - Zoheir Tekni
- School of medicine and pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco ; Department of anesthesiology, University Hospital Hassan II, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco
| | - Hind Laachach
- School of medicine and pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco ; Department of Cardiology, University Hospital Hassan II, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco
| | - Amal Bennani
- School of medicine and pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco ; Department of pathology, University Hospital Hassan II, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco
| | - Youssef Zrihni
- School of medicine and pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco ; Department of surgery, University Hospital Hassan II, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco
| | - Azeddine Tadmori
- School of medicine and pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco ; Department of endocrinology, University Hospital Hassan II, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco
| | - Farida Ajdi
- School of medicine and pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco ; Department of endocrinology, University Hospital Hassan II, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco
| | - Abderahim Bouazzaoui
- School of medicine and pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco ; Department of anesthesiology, University Hospital Hassan II, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco
| | - Laila Chbani
- School of medicine and pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco ; Department of pathology, University Hospital Hassan II, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco
| | - Hafid Akoudad
- School of medicine and pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco ; Department of Cardiology, University Hospital Hassan II, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco
| | - Khalid Mazaz
- School of medicine and pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco ; Department of surgery, University Hospital Hassan II, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco
| | - Said Aitlaalim
- School of medicine and pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco ; Department of surgery, University Hospital Hassan II, BP: 1893, km 2.200, route de Sidi Hrazem, Fez, 30000 Morocco
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12
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Karkera M. A ruptured pheochromocytoma: an unlikely cause of Brown-Sequard syndrome. J Clin Anesth 2014; 26:159-60. [PMID: 24582183 DOI: 10.1016/j.jclinane.2013.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/08/2013] [Accepted: 10/08/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Megha Karkera
- Department of Anesthesiology University of Arkansas for Medical Sciences Little Rock, AR 72205, USA.
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13
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Adrenal artery embolization: anatomy, indications, and technical considerations. AJR Am J Roentgenol 2013; 201:190-201. [PMID: 23789675 DOI: 10.2214/ajr.12.9507] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this review is to describe adrenal arterial anatomy and to discuss the indications, outcomes, and technical considerations of adrenal artery embolization. CONCLUSION Adrenal artery embolization can be used for management of adrenal tumors (palliative for pain relief, debulking, or hormone suppression) and treatment of acute bleeding from ruptured adrenal tumors, traumatic adrenal injury, and aneurysms. Variant arterial supplies, options for embolic agents, and potential complications are important considerations.
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14
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Kumar S, Nanjappa B, Kumar S, Prasad S, Pushkarna A, Singh SK. Adrenal artery pseudoaneurysm in pheochromocytoma presenting with catastrophic retroperitoneal haemorrhage. Can Urol Assoc J 2013; 7:E254-6. [PMID: 23671538 DOI: 10.5489/cuaj.541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Spontaneous rupture of adrenal pheochromocytoma is an extremely rare condition which presents as an abdominal catastrophe. Unrecognized, this transformation can rapidly lead to death. We report a case of a 63-year-old male who presented with hemorrhagic shock secondary to ruptured adrenal pheochromocytoma. The clinical course is notable for immediate transarterial catheter embolization for control of bleeding, followed by optimization and elective adrenalectomy. High mortality is associated with an operative intervention in the face of an unrecognized pheochromocytoma. This reinforces the need for maintaining a high index of suspicion in the setting of a suprarenal mass despite hypotension.
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Affiliation(s)
- Santosh Kumar
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Gómez Hernández MT, Franch-Arcas G, González Sánchez C, Sánchez-Jiménez R, Cerro-Martínez M. Hemorragia retroperitoneal tras rotura traumática de un feocromocitoma. Cir Esp 2013; 91:197-9. [DOI: 10.1016/j.ciresp.2011.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 11/12/2011] [Accepted: 11/17/2011] [Indexed: 10/28/2022]
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Gómez Hernández MT, Franch-Arcas G, González Sánchez C, Sánchez-Jiménez R, Cerro-Martínez M. Hemorragia retroperitoneal tras rotura traumática de un feocromocitoma. Cir Esp 2013. [DOI: 10.1016/j.ciresp.2011.11.014 epub 2012 mar 14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Spontaneous adrenal hemorrhage with associated masses: etiology and management in 6 cases and a review of 133 reported cases. World J Surg 2012; 36:75-82. [PMID: 22057755 DOI: 10.1007/s00268-011-1338-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND Spontaneous adrenal hemorrhage associated with a mass is uncommon and treatment strategies are not standardized. Current treatment modalities range from supportive management and blood transfusion to embolization or immediate operative extirpation. Our objectives were to describe six cases from a single institution and to perform a literature review of the etiology of the condition and recommended management of patients with hemorrhagic adrenal masses. METHODS Records from six patients diagnosed with adrenal hemorrhage and an associated mass at a single institution were reviewed. Clinical records and outcomes were analyzed. A comprehensive review of 133 reported cases in the literature was performed. RESULTS Six patients presented with spontaneous adrenal hemorrhage that appeared to be associated with a mass, with tumor sizes ranging from 3.7 to 15 cm. Three patients underwent adrenalectomy for pheochromocytoma or adrenocortical cancer. Three patients did not undergo adrenalectomy: one had a metastasis from lung cancer, one underwent embolization, and one had resolution of the mass on interval imaging. A comprehensive review of the literature identified 133 cases, with pheochromocytoma the most commonly reported lesion (48%). CONCLUSIONS Spontaneous adrenal hemorrhage is rare. When it does occur, a high level of suspicion for malignant disease or pheochromocytoma should be maintained. The possibility of a hematoma masquerading as a neoplasm should also be considered. In cases of ongoing hemorrhage, embolization may be a lifesaving temporizing measure. Acute surgical intervention should be considered in selected patients, and surgery may not be required in all patients. A cautious approach with a comprehensive biochemical and imaging work-up is advised prior to operation.
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