Nonfunctional adrenocortical carcinoma initially presenting as retroperitoneal hemorrhage

Area of Science:

• Endocrinology
• Surgical Oncology
• Interventional Radiology

Background:

• Acute adrenal hemorrhage is rare, with trauma being the most common cause.
• Non-traumatic etiologies, including spontaneous rupture, are infrequently reported.
• Adrenocortical carcinoma is an uncommon adrenal malignancy.

Observation:

• A 47-year-old woman presented with acute severe retroperitoneal hemorrhage.
• Computed tomography revealed a bleeding tumor in the left adrenal gland.
• The hemorrhage was attributed to a ruptured adrenocortical carcinoma.

Findings:

• Successful emergency transcatheter embolization of the bleeding adrenal artery was performed.
• Subsequent elective left adrenalectomy via laparotomy confirmed adrenocortical carcinoma.
• The patient experienced a successful recovery.

Implications:

• This case demonstrates the feasibility of managing spontaneous adrenal hemorrhage from adrenocortical carcinoma with a combined interventional radiology and surgical approach.
• Early diagnosis and prompt intervention are crucial for favorable outcomes in such critical cases.
• Highlights the importance of considering non-traumatic causes of adrenal hemorrhage, including malignancy.