Nontraumatic rupture of an adrenal gland tumor causing intra-abdominal or retroperitoneal hemorrhage in four dogs

Abstract

Diagnosis and surgical management of intra-abdominal or retroperitoneal hemorrhage in 4 dogs with rupture of an adrenal gland tumor were determined. All 4 dogs were lethargic and weak with pale mucous membranes on initial examination. Three dogs did not have any history of clinical signs of hyperadrenocorticism or pheochromocytoma prior to examination. In 3 of the dogs, a mass in the area of the adrenal gland was identified with ultrasonography prior to surgery. All dogs developed ventricular premature contractions before or during anesthesia. Three dogs survived adrenalectomy; 1 dog was euthanatized during surgery because of an inability to achieve adequate hemostasis. The remaining 3 dogs all survived more than 5 months after surgery; 1 was euthanatized 9 months after surgery because of rupture of a hepatic mass. On the basis of these results, we suggest that hemodynamic stabilization followed by adrenalectomy is the treatment of choice for dogs with nontraumatic rupture of an adrenal gland tumor and resulting life-threatening hemorrhage.

Pheochromocytoma and Multiple Endocrine Neoplasia

“…Occlusion of the vena cava caudalis (partial or complete) is either by tumor thrombosis within the lumen or by large tumor sizeboth may cause ascites, hind limb edema, and distention of the caudal epigastric veins. Dogs with tumor rupture are presented with acute onset of lethargy, tachypnea, weakness or collapse, tachycardia, pale mucus membranes, prolonged capillary refill time, and painful abdomen (Whittemore et al, 2001;Williams and Hackner, 2001). Aortic thromboembolism with painful and weak hind limbs, paraparesis, absence of femoral pulse, and cold distal extremities may occur in rare cases (Gilson et al, 1994;Santamarina et al, 2003).…”

Urinary Tract

“…The lack 111,112 Urine leakage initiates a fibroblastic reaction encapsulating the urine in the retroperitoneal tissues, which may obstruct the ureter. 127,128,131 Retroperitoneal abscesses are usually complex masses that have thickened, irregular walls; they often present as anechoic to hypoechoic masses, with or without septa and particulate internal debris. Retroperitoneal hemorrhage may occur from trauma, coagulopathies, renal and adrenal gland tumors, retroperitoneal foreign bodies or tumors, and vascular anomalies.…”

Adrenal Glands

“…In the more recent study, a left adrenal gland diameter of less than 3.2 mm was strongly suggestive of hypoadrenocorticism when compared to healthy dogs. 7,45,48,63,64 A careful search of adjacent structures, other abdominal organs, and thoracic radiographs to rule out metastasis is recommended when an adrenal tumor is suspected. However, CVC thrombosis in the absence of an adrenal tumor must also be considered because of the hypercoagulable state that accompanies hyperadrenocorticism.…”