Non-surgically treated case of nonfunctioning ruptured adrenal adenoma in a patient on hemodialysis

• Published in: Endocrine 2019-07, Vol.65 (1), p.213-216
• Main Authors: Lee, Kyung Ae, Jin, Heung Yong
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal Pain - etiology; Abdominal Pain - therapy; Adenoma; Adrenal Cortex Neoplasms - complications; Adrenal Cortex Neoplasms - pathology; Adrenal Cortex Neoplasms - therapy; Adrenalectomy; Adrenocortical Adenoma - complications; Adrenocortical Adenoma - pathology; Adrenocortical Adenoma - therapy; Aged; Case reports; Computed tomography; Diabetes; Disease management; Embolization; Embolization, Therapeutic; Emergency medical care; Endocrine Imaging; Endocrinology; Gastrointestinal Hemorrhage - therapy; Hematoma; Hematoma - complications; Hematoma - therapy; Hemodialysis; Hemorrhage; Humanities and Social Sciences; Humans; Internal Medicine; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Male; Medicine; Medicine & Public Health; multidisciplinary; Pain; Renal Dialysis; Retroperitoneal Space - pathology; Rupture; Rupture, Spontaneous - complications; Rupture, Spontaneous - pathology; Rupture, Spontaneous - therapy; Science; Trauma; Tumors
• ISSN: 1355-008X; 1559-0100
• DOI: 10.1007/s12020-019-01948-3

Objectives Herein, we report a case of rupture of nonfunctional adrenal adenoma treated by nonsurgical supportive management due to high risk for operation. Method and case A patient with end stage renal disease (ESRD) who was on hemodialysis visited our emergency room and complained of a sudden abdominal pain after a fall. A retroperitoneal hemorrhage with hematoma formation around the adrenal adenoma, which was caused by rupture of the adrenal adenoma, was detected by abdominal computed tomography (CT). Results Supportive management was performed, with serial CT follow-up instead of surgical adrenalectomy treatment because of high operative risk, due to hemodialysis. After 1 week, the patient’s vital signs stabilized and the patient did not further complain about abdominal symptoms. However, supportive embolization was performed and the size of hematoma was more decreased. Conclusion We report a case of a patient on hemodialysis who experienced a rupture of a nonfunctioning adrenal adenoma, which was caused by low-energy trauma. The patient’s conditions improved with nonsurgical supportive management including embolization. Learning point for clinicians Physicians should consider both surgical and nonsurgical management for the rupture of adrenal adenomas, depending on the patient situation. Therefore, nonsurgical supportive management such as embolization can be one therapeutic option for treating nonfunctioning adrenal adenoma rupture caused by low-energy trauma in a patient who has risks for operation due to combined comorbidities.