title: Spontaneous adrenal hemorrhage with associated masses: etiology and management in 6 cases and a review of 133 reported cases.
abstract: BACKGROUND
  Spontaneous adrenal hemorrhage associated with a mass is uncommon and treatment strategies are not standardized. Current treatment modalities range from supportive management and blood transfusion to embolization or immediate operative extirpation. Our objectives were to describe six cases from a single institution and to perform a literature review of the etiology of the condition and recommended management of patients with hemorrhagic adrenal masses.
  
  
  METHODS
  Records from six patients diagnosed with adrenal hemorrhage and an associated mass at a single institution were reviewed. Clinical records and outcomes were analyzed. A comprehensive review of 133 reported cases in the literature was performed.
  
  
  RESULTS
  Six patients presented with spontaneous adrenal hemorrhage that appeared to be associated with a mass, with tumor sizes ranging from 3.7 to 15 cm. Three patients underwent adrenalectomy for pheochromocytoma or adrenocortical cancer. Three patients did not undergo adrenalectomy: one had a metastasis from lung cancer, one underwent embolization, and one had resolution of the mass on interval imaging. A comprehensive review of the literature identified 133 cases, with pheochromocytoma the most commonly reported lesion (48%).
  
  
  CONCLUSIONS
  Spontaneous adrenal hemorrhage is rare. When it does occur, a high level of suspicion for malignant disease or pheochromocytoma should be maintained. The possibility of a hematoma masquerading as a neoplasm should also be considered. In cases of ongoing hemorrhage, embolization may be a lifesaving temporizing measure. Acute surgical intervention should be considered in selected patients, and surgery may not be required in all patients. A cautious approach with a comprehensive biochemical and imaging work-up is advised prior to operation.
authors: Division of Endocrine Surgery, Department of Surgery, Yale University School of Medicine, 333 Cedar Street, TMP 202, New Haven, CT 06520, USA.
authors: Jennifer L
authors: JL
authors: Marti
authors: John
authors: J
authors: Millet
authors: Julie Ann
authors: JA
authors: Sosa
authors: Sanziana A
authors: SA
authors: Roman
authors: Tobias
authors: T
authors: Carling
authors: Robert
authors: R
authors: Udelsman
mesh_terms: D000307:Adrenal Gland Diseases / Q000209:etiology* / Q000628:therapy; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D004621:Embolization, Therapeutic; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies