ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 EP11 | DOI: 10.1530/endoabs.63.EP11

Adrenal hematoma: two cases report

Joana Reis Guiomar1, Carolina Moreno1, Isabel Paiva1, Luís Miguel Cardoso1, Joana Saraiva1, Dírcea Rodrigues1, Nelson Cunha1, Diana Catarino1, Lúcia Fadiga1, Diana Festas Silva1, Arnaldo Figueiredo2, Maria João Martins3 & Margarida Bastos1


1Endocrinology, Diabetes and Metabolism Department, Coimbra Hospital and University Center, EPE., Coimbra, Portugal; 2Urology and Renal Transplantation Department, Coimbra Hospital and University Center, EPE., Coimbra, Portugal; 3Pathological Anatomy Department, Coimbra Hospital and University Center, EPE., Coimbra, Portugal.


Introduction: Adrenal hematomas are a relatively rare clinical condition and its prevalence has been reported to be about 1%. Although various causes have been proposed, the ethology and pathophysiology are still not fully understood, and the symptoms range is very variable, from asymptomatic situations to haemorrhagic shock. Imaging is a challenging method to establish the diagnosis of adrenal hematomas, and in most cases, it is only possible after surgery. Surgery is routinely recommended if there is a suspicion of malignancy.

Case Report: We present two cases of adrenal hematomas with diagnosis after surgical intervention and histopathological examination. Male, 81 years old, referred to outpatient clinic by incidentaloma on right adrenal gland, heterogeneous, hypovascular, with 8.1 cm, in an imaging study by renal lithiasis. Personal history of controlled hypertension, atrial fibrillation and dyslipidaemia. Medicated with furosemide 40 mg id, candersatan 10 mg id, dabigatran 110 mg 2 id and simvastatin 20 mg id. No family history. Analytical evaluation without alterations suggesting non-functioning nodule and CT showing: ‘expansive formation in the right adrenal with 11.2 cm that could be a benign lesion but cannot exclude carcinoma or pheochromocytoma’. Performed a right adrenalectomy, without immediate complications. Pathological anatomy with nodular and expansive lesion of the right adrenal, organized into a hematoma. A 63-year-old woman, referred to outpatient clinic for a nodule on left adrenal, discovered during the study of hypertensive spikes. Personal history of hypertension, dyslipidaemia and depressive syndrome. Medicated with carvedilol 6.25 mg 2 id, atorvastatin 40 mg id and quetiapine 20 mg id. No family history. Analytical evaluation compatible with non-functioning nodule and CT: ‘At the level of the left adrenal, there are two regular nodules with well-defined borders, one homogenous and hypodense suggestive of adenoma, another spontaneously regular heterogeneous measuring 4.2 × 2.3 cm, washout 30%, which may correspond to an expansive process (…)’. Performed left adrenalectomy by laparoscopy without immediate complications. Pathological anatomy compatible with left adrenal hematoma.

Conclusions: Adrenal hematomas are usually caused by trauma, surgery, anti-coagulant therapy, haemorrhagic diathesis, septicaemia, adrenal neoformation or systemic disease. However, due to the highly vascularized and vulnerable nature of the adrenal gland, it isn’t always possible to identify a risk factor. Incidentalomas ≥4 cm and/or growth ≥ 20% in 6/12 months, with uncertainty in the diagnosis are often surgical indication. There are no established follow-up protocols and is unknown the risk of postoperative recurrence in the contralateral gland.