Endocrine Abstracts

Background: The adrenal hemorrhage is rare and potentially lethal. Its diagnosis is difficult because atypical. We report the case of a patient beautifully treated by embolization of the adrenal artery.

Case report: A 68-year-old female patient admitted for abdominal pain, with as background, a diabetes, atrial fibrillation under anticoagulation with recent relay Previscan Innohep and a right adrenal incidentaloma (for 9 years, 43 mm of centerline and density spontaneous < 10 UH, never explored). Explorations concluded unilateral active bleeding on right adrenal adenoma. Evolution was made towards a deglobulisation motivating the transfusion of two globular units and the realization of an embolization of the right adrenal artery, in less than 10 minutes (see images) to postpone surgery. Given the non-embolic nature of the atrial fibrillation, anticoagulants were arrested and 3 weeks later, the scanner objective regression of the hematoma. Hormonal exploration of adenoma was normal and the patient, waiting for its resection.

Discussion-conclusion: This case reports an unusual and efficient treatment of adrenal hemorrhage. On 24 patients with adrenal hemorrhage after adrenal catheterization, no gesture was made¹. Another series reported surgery in 40%, but not selective embolization². A few gestures of embolization have been described in the context of bleeding on the adrenal artery aneurysms³. An adequate technical platform and a confirmed radiologist is vital. We do not know if this gesture can improve the subsequent functional prognosis of the adrenal and would therefore be preferable to an adrenalectomy.

References: 1. Monticone S, Satoh F, Dietz AS, Goupil R, Lang K, Pizzolo F, Gordon RD, Morimoto R, Reincke M, Stowasser M, Mulatero P. Clinical Management and Outcomes of Adrenal Hemorrhage Following Adrenal Vein Sampling in Primary Aldosteronism. Hypertension. 2016 Jan;67(1):146–52.

2. Karwacka IM, Obołończyk Ł, Sworczak K. Adrenal hemorrhage: A single center experience and literature review. Adv Clin Exp Med. 2018 Mar 27.

3. Patel A, Downing R, Vijay S. Spontaneous rupture of the adrenal artery successfully treated using the endovascular approach: a report of 2 cases. Vasc Endovascular Surg. 2013 Feb;47(2):124–7.