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Case Reports
. 2020 Dec 17;13(12):e236050.
doi: 10.1136/bcr-2020-236050.

Ruptured functioning adrenal tumour, atypical presentation with renal colic and hypertension

Amr Elmoheen  1 , Mohamed Yousry  2 , Ahmed Elmesery  3 , Khalid Bashir  2
Affiliations
Case Reports

Ruptured functioning adrenal tumour, atypical presentation with renal colic and hypertension

Amr Elmoheen et al. BMJ Case Rep. .

Abstract

Pheochromocytomas are uncommon tumours that originate in chromaffin cells. They are a representation of 0.1%-1% of all cases of secondary hypertension. Most pheochromocytomas are unilateral and benign, featuring catecholamine production, as well as the production of other neuropeptides. Pheochromocytomas are mostly located in the adrenal gland; the frequency of occurrence is highest between 30 and 50 years of age; however, up to 25% of cases may be linked to multiple endocrine neoplasia type 2, Von-Hippel-Landau disease and type 1 neurofibromatosis in the young.We present a case of ruptured left adrenal pheochromocytoma with an atypical presentation. A 30-year-old male patient presented with severe left flank pain and hypertension. The CT scan of the abdomen showed bleeding from the left adrenal mass, where resuscitation and angioembolisation were done. Embolisation of the inferior and superior arteries was done, but the middle failed. The patient experienced a significant drop in haemoglobin and a haemorrhagic shock post angioembolisation, which called for emergency laparotomy. The patient is currently doing well with an uneventful postoperative course.

Keywords: adrenal disorders; emergency medicine; endocrine cancer; radiology; resuscitation.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
CT of the abdomen and urinary tract showed a large soft tissue like lesion at the left adrenal region with hyperdensities within (red arrow), pushing the left kidney downward and laterally with severe surrounding fat stranding and perinephric fluid.
Figure 2
Figure 2
CT abdominal angiography showed posteromedial active extravasation of contrast seen on the arterial phase (red arrow), venous phase (blue arrow), and fade mostly at the delay phase (green arrow).
Figure 3
Figure 3
Transarterial selective left adrenal artery embolisation; selective catheterisation of the left superior adrenal artery (A), selective catheterisation of the left inferior adrenal artery (B), embolisation with a tiny amount of 350–500 particles (C).
Figure 4
Figure 4
Follow-up CT abdomen with contrast showed no recurrence of the mass.
See this image and copyright information in PMC

References

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