Non-Traumatic Unilateral Spontaneous Adrenal Mass Rupture: A Retrospective Case Series Study

Background and Objectives: Non-traumatic spontaneous adrenal mass rupture (SAMR) is a rare and life-threatening surgical emergency. It has around a 32% mortality rate based on the underlying pathology. We aimed to explore the presentations, management, and outcomes of SAMR with various pathologies. Materials andMethods: We reviewed electronic and operative records over the last eight years to identify SAMR at our institute. Patients' demographics, comorbidities, presentations, pathology, interventions, and outcomes were analyzed. Results: There were 14 unilateral SAMR patients who arrived at the emergency department (ED)presenting with abdominal pain. The median age at presentation was 34 years (range 27-56). In total, 12 patients were male (83.3%), and 2 were female, including a 32-week-pregnant woman. Ten were South Asians and four were Arabs. All the patients with SAMR did not have a history of prior adrenal disorders. Nine patients had hypotension at presentation. After the initial clinical examination, the patients underwent a computed tomography (CT) scan in the ED, which revealed unilateral SAMR. There was no medical history of adrenal mass or trauma prior to index admission. The CT scan size of the masses ranged from 5.5 to 23.6 cm (eight were right-sided and six left-sided). Time to intervention ranged from 1 to 11 days. Histopathology showed four pheochromocytomas, four myelolipomas, three normal adrenal tissues with hemorrhagic cysts, one adrenal gland hemorrhage, one pseudocyst, and one angiosarcoma. Six adrenal masses were non-functioning. All patients were managed with open adrenalectomy (two had pre-operative interventional radiological embolization). Blood transfusion was required in most cases. Ten patients required post-operative surgical intensive care with an average stay of 2.42 days. There were no perioperative deaths during the hospital course. Conclusions: Ruptured adrenal masses most commonly present with acute abdominal pain requiring urgent surgical intervention, particularly in patients with hemodynamic instability, insufficient initial conservative management or malignancy. Despite the dramatic presentation, outcomes are favorable in experienced centers when early diagnosis and hemodynamic optimization precede interventions and are accompanied by multidisciplinary team involvement.