Endocrine Abstracts

Introduction: Adrenal hematomas are very rare entities. They occur often associated with: trauma, anticoagulation, coagulopathy, septicemia, pregnancy complications or tumors. When none of these predisposing factors is present, diagnosis and treatment can become a real challenge.

Case report: A 19-years-old woman presented with complaints of asteny, loss of appetite, loss of 10 kg in a month, and pain in right lumbar and abdominal regions. No other complaints, such as increase of pilosity, menstrual irregularities, headache, palpitations or sweating. No previous diseases; no chronic medication. When subjected to palpation of right abdominal quadrants, a mass was found that revealed hard to define. Patient was then submitted to an abdominal computed tomography (CT) which revealed in place of right adrenal, an expansive formation of oval morphology, regular edges and well defined limits, with 7×6, 5×5 cm, homogenous texture, only with thin parietal calcifications which seemed like a complex cystic lesion. The most likely hypothesis was a residual hematoma. All laboratory findings were normal (hemogram with platelets, coagulation, renal and liver function, thyroid function, baseline hormone levels of pituitary, gonadal function, urinary free cortisol, ACTH-cortisol rhythm). Patient was submitted to a right adrenalectomy and no complications were developed. The final pathological diagnosis of excised specimen was compatible with an organized adrenal hematoma. Three weeks later the patient was admitted to our department for re-evaluation. At the time was completely asymptomatic; hormonal evaluation was normal. Abdominal CT showed only a right adrenalectomy. Study was made to rule out coagulopathy. Patient was then scheduled a hematology appointment.

Conclusions: When faced with an image on the adrenal gland compatible with a hematoma, it`s necessary to rule out underlying adrenal tumors (through hormonal evaluation) and to research the existence of predisposing factors for the formation of a hematoma. Only the pathological study of excised specimen allows a definitive diagnosis.