Bleeding angiomyolipoma mimiking a ruptured adrenal tumour

Nerli, Rajendra B; Ghagane, Shridhar C; Kadeli, Vishal; Nutalpati, Shreeharsha; Mohan, Sham; Hiremath, Murigendra B

doi:10.1016/j.eucr.2019.101031

Cited by 3 publications

(3 citation statements)

References 5 publications

(6 reference statements)

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“…The majority of renal AMLs are asymptomatic; however, abdominal and flank pain and haematuria are typical clinical symptoms [ 27 ]. The most serious complication of ALMs is the spontaneous bleeding resulting from lesion rupture due to its increasing size [ 28 - 30 ]. It might induce hemodynamic instability and shock in some instances [ 31 ].…”

Section: Reviewmentioning

confidence: 99%

Active Surveillance for Renal Angiomyolipoma Less Than 4 Centimeters: A Systematic Review of Cohort Studies

Zeid¹,

Sayedin²,

Nabi³

et al. 2022

Cureus

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The aim of this review is to evaluate the current evidence regarding the best management in terms of active surveillance of angiomyolipoma (AML) cases less than 4 cm, particularly the optimal timing of active surveillance. In addition, we aimed to describe their initial size, clinical presentation, and growth rates. The present systematic review included prospective and retrospective studies that evaluated and followed up patients with AML through active surveillance. Studies were retrieved through an online bibliographic search of the Medline database via PubMed, SCOPUS, Web of Science, and Cochrane Library from their inception to January 2022. Seven studies were included in the present systematic review. Concerning the active surveillance protocol, only four studies describe the frequency of active surveillance and the utilized imaging modality. Some studies followed up lesions by ultrasound annually for two to five years, while other studies followed-up patients twice for the first year, then annually for a median follow-up period of 49 (9-89) months. The used modalities were ultrasound, CT, and magnetic resonance imaging (MRI). Notably, the incidence of spontaneous bleeding was consistent across the included studies (ranging from 2.3 -3.1%), except for one study which showed an incidence rate of 15.3%. In terms of the need for active treatment, the rate of active treatment was slightly higher in some studies than the others. However, this variation could not be considered clinically relevant to favor one surveillance strategy over the other. We concluded that active surveillance is the first line of management in all small asymptomatic ALMs. ALMs less than 2 cm do not require active surveillance. The current published literature suggested that active surveillance for two years may provide the same benefits as a five-year surveillance strategy, with fewer radiation hazards and less socioeconomic burden.

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Section: Reviewmentioning

confidence: 99%

Active Surveillance for Renal Angiomyolipoma Less Than 4 Centimeters: A Systematic Review of Cohort Studies

Zeid¹,

Sayedin²,

Nabi³

et al. 2022

Cureus

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“…2 Most of the angiomyolipomas occur among females and rarely develop before puberty. 3 Angiomyolipomas are solid tumours composed of dysmorphic blood vessels, adipose tissues and smooth muscles, and which are strongly expressing B progesterone, oestrogen, and androgen receptors which suggest a hormonal influence for their growth. 3,4 The diagnosis of angiomyolipomas is incidental in more than 80% of the cases through the crosssectional imaging, as the finding of macroscopic fat within a lesion is the hallmark of all modalities.…”

mentioning

confidence: 99%

“…3 Angiomyolipomas are solid tumours composed of dysmorphic blood vessels, adipose tissues and smooth muscles, and which are strongly expressing B progesterone, oestrogen, and androgen receptors which suggest a hormonal influence for their growth. 3,4 The diagnosis of angiomyolipomas is incidental in more than 80% of the cases through the crosssectional imaging, as the finding of macroscopic fat within a lesion is the hallmark of all modalities. 2,5 However, the rest of the cases are diagnosed after a complication has happened such as spontaneous retroperitoneal haemorrhage, where the patients will present with the following signs and symptoms; flank pain, palpable mass, haematuria, anaemia, renal failure or urinary tract infection.…”

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confidence: 99%

Rupture of Renal Angiomyolipoma Post Fibrinolysis

Al-Kindi,

Al-Hajriy,

Al-Jabri

2023

Sultan Qaboos Univ Med J

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Angiomyolipoma is a common benign solid tumour that accounts for up to 3% of all renal tumours; most of the cases are sporadic. However, it can be part of other diseases. Angiomyolipomas are usually found incidentally through unrelated clinically indicated images but also, they can be diagnosed after complications have occurred. We report the case of retroperitoneal haemorrhage following the rupture of renal angiomyolipoma post-fibrinolysis, we are highlighting such a rare condition, the management options and the follow-up plan. The management of angiomyolipomas ranges from conservative treatment to surgical intervention depending on the patient’s condition and the tumour’s radiological features. Following-up on patients with angiomyolipomas depends on the symptoms and the tumour size. Till date, there is no reported cases of renal angiomyolipoma rupture post-fibrinolysis therapy as a treatment for myocardial infarction in non-percutaneous intervention capable facility. Keywords: Angiomyolipoma; Myocardial Infarction; Fibrinolysis, Retroperitoneal; Hemorrhage; Artery Embolization; Percutaneous Intervention.

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Adrenal bleeding due to pheochromocytoma - A call for algorithm

et al. 2022

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BackgroundAdrenal 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 methodsWe 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.ResultsIn 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%.ConclusionsDiagnosis 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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Bleeding angiomyolipoma mimiking a ruptured adrenal tumour

Cited by 3 publications

References 5 publications

Active Surveillance for Renal Angiomyolipoma Less Than 4 Centimeters: A Systematic Review of Cohort Studies

Active Surveillance for Renal Angiomyolipoma Less Than 4 Centimeters: A Systematic Review of Cohort Studies

Rupture of Renal Angiomyolipoma Post Fibrinolysis

Adrenal bleeding due to pheochromocytoma - A call for algorithm

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