title: Adrenal hemorrhage as the first presentation of hepatocellular carcinoma.
abstract: We report a 67-year-old man who presented with sudden onset of pain in the left flank in association with anemia and hypotension. Imaging studies revealed hepatocellular carcinoma (HCC) at the right lobe of the liver with bilateral adrenal metastases and recent hemorrhage in the left adrenal gland. His serology for hepatitis C was positive. Abdominal exploration with left adrenalectomy was performed. The postoperative course of the patient was uneventful and three cycles of transarterial chemoembolization (TACE) were administered. His general condition gradually deteriorated, and he died 6 months after surgery. Spontaneous massive AH due to metastatic HCC is unusual. Considering the high incidence of HCC in Asia, clinicians should be aware of this atypical and fatal presentation.
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok.
authors.forename: Padiporn
authors.initials: P
authors.lastname: Vasinanukorn
authors.forename: Rungsun
authors.initials: R
authors.lastname: Rerknimitr
authors.forename: Suvit
authors.initials: S
authors.lastname: Sriussadaporn
authors.forename: Naruemon
authors.initials: N
authors.lastname: Wisedopas
authors.forename: Pradermchai
authors.initials: P
authors.lastname: Kongkam
authors.forename: Bundit
authors.initials: B
authors.lastname: Chaopapsomkul
authors.forename: Thiti
authors.initials: T
authors.lastname: Snabboon
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000556:secondary / Q000601:surgery* / Q000628:therapy; D000315:Adrenalectomy; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000556:secondary* / Q000628:therapy / Q000821:virology; D016461:Chemoembolization, Therapeutic; D017809:Fatal Outcome; D006470:Hemorrhage / Q000601:surgery*; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy / Q000821:virology; D008297:Male