Idiopathic Unilateral Adrenal Haemorrhage and Adrenal Mass: A Case Report and Review of the Literature

Abstract

We report an unusual case of idiopathic unilateral adrenal haemorrhage (AH) in a 55-year-old patient. This rare case had two characteristics that made it worth of report. First, idiopathic adrenal haemorrhage is very uncommon, and second it was presented as a huge, 23 cm diameter and 2,123 gr weight, “silent” adrenal mass. It is important to distinguish a benign lesion like this from a neoplasm, although we were not able to identify it preoperatively and the diagnosis was only made after the excised specimen was examined by a group of experienced histopathologists. Only a few similar published cases, to our knowledge, are described in the worldwide literature and even fewer of this size.

Adrenal Hematoma Simulating Malignancy in Idiopathic Thrombocytopenic Purpura

“…Spontaneous idiopathic adrenal hematomas were also reported [2,5,7,8]. Clinical presentation of adrenal hematomas varies, and may include flank or abdominal pain (like in our patient), fever, tachycardia, weakness, hypotension, nausea, vomiting, changes in mental status, weight loss, abdominal distention and palpable abdominal mass [2].…”

“…According to the literature, adrenal hematomas usually appeared as rounded or oval hypodense heterogeneous masses with or without calcifications, and absence of contrast enhancement. Benign adrenal lesions bigger than 6 cm are extremely rare and always should be surgically excised, after evaluation for possible secreting adrenal tumor [2,3]. Adrenal hematomas could masquerade malignant neoplasm like in our patient, who had 7 × 9 × 6 cm adrenal mass, enhancing with IV contrast.…”

“…These lesions were most commonly described as a consequence of trauma, but also in patients taking non-steroidal anti-inflammatory drugs (NSAIDs), with neurofibromatosis, after liver transplantation, with primary and metastatic adrenal tumors, with heparin-associated thrombocytopenia, on anticoagulation, on hormonal therapy, with severe sepsis and anti-phospholipid antibodies [2][3][4]. Spontaneous idiopathic adrenal hematomas were also reported [2,5,7,8]. Clinical presentation of adrenal hematomas varies, and may include flank or abdominal pain (like in our patient), fever, tachycardia, weakness, hypotension, nausea, vomiting, changes in mental status, weight loss, abdominal distention and palpable abdominal mass [2].…”

“…Lesions larger than 6 cm are rarely benign and should be excised [2]. We present a 65-year-old female with ITP and 7 × 9 × 6 cm adrenal hematoma, simulating malignancy.…”

“…They were reported in patients with trauma, long-term use of nonsteroidal anti-inflammatory drugs, neurofibromatosis, liver transplantation, primary and metastatic adrenal tumors, heparin-associated thrombocytopenia, anticoagulation, sepsis, and anti-phospholipid antibodies [2][3][4]. Adrenal hemorrhage could be spontaneous [2], and sometimes has clinical and radiographic features of adrenal neoplasm [2,3,[5][6][7][8][9].…”