Endocrine Abstracts

Adrenal haemorrhage is a rare, usually life-threating complication, most commonly connected with primary or metastatic adrenal tumour. Among them pheochromocytoma is the most common cause of spontaneous adrenal bleeding and accounts for nearly 50% of cases. We performed a database search for pheochromocytoma patients, diagnosed and treated in Endocrinology Department, University Hospital in Cracow from 2005 to 2021. 206 patients with pheochromocytoma were identified. Subsequently, 23 cases were excluded due to incomplete medical data necessary to rule out potential adrenal bleeding. Of the remaining 183 patients with histologically confirmed pheochromocytoma, 7 cases with adrenal bleeding were found (3.8% of cases). The group of patients comprise 4 men and 3 women. Median patient’s age was 49 years (range: 36-78 years). The most common manifestation of adrenal bleeding was acute abdominal pain (71.4%). Two patients (28.6%) developed shock, in one case resulted in multiple organ failure (MOF). Hormonal assessment concerning pheochromocytoma were performed in five patients (71.4%). 24- h urinary fractionated metanephrines were significantly elevated in all of them. Most patients (85.7%) have had symptoms suggestive of pheochromocytoma before haemorrhage − most commonly paroxysmal hypertension (57.1%). Nevertheless, In four patients diagnosis of pheochromocytoma was made at the time of adrenal haemorrhage, based on severe clinical manifestation, hormonal status and imaging. One patient died, before the diagnosis of adrenal bleeding was made. In two patients pheochromocytoma was suspected before the episode of haemorrhage: two months and sixteen months, respectively. Six out of seven patients have diagnostic imaging performed: median largest diameter of the lesions was 7.4 cm (range: 5-11 cm). Five patients had elective surgery, preceded by two- week pharmacological treatment with alpha- receptor blockers. In one case, four-day alpha-receptor blockage was administered, followed by the urgent surgery. In all cases the diagnosis of pheochromocytoma was confirmed in postoperative histopathology or in autopsy. PASS score was defined in 5 patients - in three cases it was no higher than 3, in two cases it exceeded 3. In two another cases, because of massive haemorrhagic changes, it couldn’t be determined. The perioperative survival rate was 85.7%. Adrenal bleeding is a rare complication of pheochromocytoma, which constitutes a diagnostic and therapeutic challenge. It might remain unrecognized with lethal consequences. Physicians should be aware of such diagnosis in patients with adrenal bleeding, especially with accompanying abdominal pain, hemodynamic shock and previous history of pheochromocytoma-associated symptoms.