Laparoscopic Adrenalectomy for Hemorrahagic Adrenal Pseudocyst Discovered During Pregnancy

Abstract

Adrenal pseudocysts are rare cystic masses usually nonfunctional and asymptomatic, discovered incidentally during diagnostic imaging or when complicated by rupture and hemorrhage or infection. Few cases of hemorrhagic adrenal pseudocyst during pregnancy are reported, but a causal relationship between pregnancy and pseudocyst formation has not been shown. We describe a case of a 30-year-old pregnant woman referred to our surgical unit at the 20th week of gestation for incidental detection of left-side upper abdominal cystic mass, with signs of intralesion hemorrhage. The lesion was monitored and the woman gave birth at the 39th week, without complications. After 3 months from delivery, a multislide computed tomography scan confirmed a cystic mass measuring 10×7×10 cm. An elective transperitoneal laparoscopy was performed and a well-capsulated, hemorrhagic adrenal pseudocyst was removed. The optimal surgical treatment for hemorrhagic adrenal pseudocyst during pregnancy is still controversial. The present case shows that adrenal pseudocyst should be carefully monitored and can be treated by elective laparoscopic surgery after delivery.

Surgical Management of a Giant Adrenal Pseudocyst: A Case Report and Review of the Literature in the Last Decade

“…Predisposing factors for adrenal hemorrhage, including trauma to the abdomen, infection, anoxia in infants, hemorrhagic diathesis, administration of antiplatelets or anticoagulants, embolism, and finally aneurysm, are reported in 32% of adrenal cysts [ 10 – 12 ]. There have also been reported at least 12 pregnant women with a diagnosis of adrenal pseudocysts, and a possible role of estrogens in their pathogenesis has been postulated [ 13 ]. However, there is not sufficient evidence to substantiate this theory, even if that fact would partly explain the predilection of adrenal cysts towards the female sex in general [ 13 ].…”

“…There have also been reported at least 12 pregnant women with a diagnosis of adrenal pseudocysts, and a possible role of estrogens in their pathogenesis has been postulated [ 13 ]. However, there is not sufficient evidence to substantiate this theory, even if that fact would partly explain the predilection of adrenal cysts towards the female sex in general [ 13 ].…”

“…The differential diagnosis of an adrenal pseudocyst essentially includes all the upper abdominal space-occupying lesions, such as splenic, hepatic, and renal cysts, as well as mesenteric or retroperitoneal cysts, urachal cysts, and solid adrenal tumours [ 9 , 12 , 13 , 16 ]. However, it must be noted that a preoperative diagnosis of a large adrenal pseudocyst can be very difficult indeed, due to the indistinct boundaries with surrounding organs as well as the presence of adhesions to neighboring organs [ 9 ], as in our case, where differential diagnosis of the adrenal or pancreatic origin of the mass could not be established through radiologic examination.…”

Adrenal cysts - optimal laparoscopic treatment.

“…One of the largest studies was presented by Chinese authors and encompassed 47 patients who had undergone treatment over a period of 10 years [ 6 ]. Most reports published in this area of research pertain to isolated cases or small case series [ 7 , 8 ]. The larger the studies and the groups of patients with adrenal pathologies, the higher the incidence of adrenal cysts, reaching up to 11% of the overall population [ 9 ].…”

Management of Adrenal Tumors in Pregnancy

“…34,44 Management Laparoscopic surgical resection is the treatment of choice for a cortisolsecreting adenoma discovered during pregnancy and can be done safely in the second trimester. 45,46 There is a trend toward an increase in live birth rate with treatment of CS in pregnancy, with no effect seen on premature birth or intrauterine growth restriction (IUGR) rates. However, these data may be limited by the small number of cases of CS syndrome in pregnancy, with many diagnosed later in pregnancy.…”