腎上腺單側出血臨床表現類似於嗜鉻細胞瘤，病例報告

林晏頎、吳俊德

林口長庚紀念醫院外科部 泌尿科系

Unilateral adrenal hemorrhage presents clinically similar to pheochromocytoma, a case report

Yen-Chi Lin, Chun-Te Wu

Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan

Background: Pheochromocytoma is a rare tumor of the adrenal gland, often benign, that can cause overproduction of hormones like adrenaline and noradrenaline. This excess hormone secretion can lead to symptoms such as high blood pressure, rapid heartbeat, sweating, and headaches. It's important to diagnose and manage pheochromocytoma promptly to prevent complications like adrenal hemorrhage and other cardiovascular events. Adrenal hemorrhage is an uncommon yet typically life-threatening complication. Among the various causes of spontaneous adrenal bleeding, pheochromocytoma stands out as the most prevalent neoplasm, contributing to nearly 50% of cases. Presently, there is a lack of established recommendations for diagnosing and managing patients with adrenal bleeding attributable to pheochromocytoma.

Case presentation: A 60-year-old man with no underlying disease before. He suffered from upper back soreness and chest pain for two days, so he went to emergent department for help. High blood pressure (BP) was also noted. CTA showed type B aortic dissection from arch (zone 3) to suprarenal abdominal aorta. In addition, right adrenal mass 5.8 cm with heterogenous enhancement and calcification was noted. Due to the above conditions, BP control was suggested, and he was referred to our hospital for right adrenal mass management. His urine Vanillylmandelic acid (VMA) level was 15.1mg/day, Catecholamine-norepinephrine level was 174.4 μg/day, Catecholamine-epinephrine level was 28.1                μg/day, based on these clinical presentations and laboratory workup, right pheochromocytoma was highly suspected, so robotic-assisted laparoscopic right adrenalectomy was arranged. The operation was completed successfully, however after the operation, hypertension only mild improvement, so medication was still given. The final pathologic report showed the specimen submitted consists of an adrenal gland with organizing hematoma, no viable tumor cells are presented.

Conclusions: Adrenal hemorrhage is a rare but serious complication of pheochromocytomas.  Differentiating between adrenal hemorrhage and pheochromocytoma on imaging studies is challenging.