Adrenal hemorrhage in a patient with pheochromocytoma manifested under the mask of acute surgical pathology


DOI: https://dx.doi.org/10.18565/therapy.2024.8.132-138

Katushkina Yu.A., Tatarintseva Z.G., Flore D.A., Kosmacheva E.D., Barbukhatti K.O.

1) Professor S.V. Ochapovsky Research Institute – Regional Clinical Hospital No. 1, Krasnodar; 2) Kuban State Medical University of the Ministry of Healthcare of Russia, Krasnodar
Abstract. Spontaneous adrenal hemorrhage is a rare, potentially life-threatening condition. The most common cause of its arising (almost 50% of cases) is pheochromocytoma, which worsens the negative prognosis due to the high probability of developing a catecholamine crisis. In current clinical case, the presence of abdominal pain with hemodynamic shock in an elderly female patient, as well as a history of malignant arterial hypertension with a specific crisis course, gave a cause for concern of pheochromocytoma with hemorrhage in the adrenal gland. Emergency surgery in this case is associated with a higher risk of fatal complications. The main goal of preoperative preparation of such kind of patients is to normalize blood pressure, heart rate, restore the effective volume of circulating blood, and prevent catecholamine crisis intraoperatively. Prolonged α-adrenergic receptors blockade improves the course of perioperative period and the prognosis in the whole.
Keywords: adrenal hemorrhage, pheochromocytoma, catecholamines, secondary arterial hypertension, preoperative preparation
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Literature

1. Marti J.L., Millet J., Ann J. et al. Spontaneous adrenal hemorrhage with associated Masses: Etiology and management in 6 cases and a review of 133 reported cases. World J Surg. 2012; 36(1): 75–82.


https://doi.org/10.1007/s00268-011-1338-6. PMID: 22057755.


2. Habib M., Tarazi I., Batta M. Arterial embolization for ruptured adrenal pheochromocytoma. Curr Oncol. 2010; 17(6): 65–70.


https://doi.org/10.3747/co.v17i6.597. PMID: 21151411. PMCID: PMC2993444.


3. Rebollo-Roman A., Alhambra-Exposito M.R., Herrera-Martínez Y. et al. Catecholaminergic crisis after a bleeding complication of COVID-19 infection: A case report. Front Endocrinol (Lausanne). 2021; 12: 693004.


https://doi.org/10.3389/fendo.2021.693004. PMID: 34566886. PMCID: PMC8456100.


4. Zheng W., Fung K.M., Cheng L., Osunkoya A.O. Benign vascular tumors, cysts, and pseudocysts of the adrenal gland: A contemporary multi-institutional clinicopathological analysis. Hum Pathol. 2018; 82: 95–102.


https://doi.org/10.1016/j.humpath.2018.07.013. PMID: 30041023.


5. Fang F., Ding L., He Q., Liu M. Preoperative management of pheochromocytoma and paraganglioma. Front Endocrinol (Lausanne). 2020; 11: 586795.


https://doi.org/10.3389/fendo.2020.586795. PMID: 33117294. PMCID: PMC7551102.


6. Мельниченко Г.А., Трошина Е.А., Бельцевич Д.Г. с соавт. Клинические рекомендации Российской ассоциации эндокринологов по диагностике и лечению феохромоцитомы/параганглиомы. Эндокринная хирургия. 2015; 9(3): 15–33. (Melnichenko G.A., Troshina E.A., Beltsevich D.G. et al. Clinical recommendations of the Russian Association of Endocrinologists on the diagnosis and treatment of pheochromocytoma/paraganglioma. Endokrinnaya hirurgiya = Endocrine Surgery. 2015; 9(3): 15–33 (In Russ.)).


https://doi.org/10.14341/serg2015315-33. EDN: VRHRON.


7 Tanaka K., Noguchi S., Shuin T. et al. Spontaneous rupture of adrenal pheochromocytoma: A case report. J Urol. 1994; 151(1): 120–21.


https://doi.org/10.1016/s0022-5347(17)34886-3. PMID: 8254786.


8. Ali A., Singh G., Balasubramanian S.P. Acute non-traumatic adrenal haemorrhage – management, pathology and clinical outcomes. Gland Surg. 2018; 7(5): 428–32.


https://doi.org/10.21037/gs.2018.07.04. PMID: 30505763. PMCID: PMC6234242.


9. Ahn J., Park J.Y., Kim G. et al. Urinary free metanephrines for diagnosis of pheochromocytoma and paraganglioma. Endocrinol Metab. 2021; 36(3): 697–701.


https://doi.org/10.3803/EnM.2020.925. PMID: 34107605. PMCID: PMC8258320.


10. Lenders J.W.M., Kerstens M.N., Amar L. et al. Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: A position statement and consensus of the working group on endocrine hypertension of the European Society of Hypertension. J Hypertens. 2020; 38(8): 1443–56.


https://doi.org/10.1097/HJH.0000000000002438. PMID: 32412940. PMCID: PMC7486815.


11. Karwacka I.M., Obołonczyk Ł., Sworczak K. Adrenal hemorrhage: A single center experience and literature review. Adv Clin Exp Med. 2018; 27(5): 681–87.


https://doi.org/10.17219/acem/68897. PMID: 29616752.


12. Pacak K. Preoperative management of the pheochromocytoma patient. J Clin Endocrinol Metab. 2007; 92(11): 4069–79.


https://doi.org/10.1210/jc.2007-1720. PMID: 17989126.


13. Roizen M.F., Hunt T.K., Beaupre P.N. et al. The effect of alpha-adrenergic blockade on cardiac performance and tissue oxygen delivery during excision of pheochromocytoma. Surgery. 1983; 94(6): 941–45. PMID: 6648809.


14. Zawadzka K., Więckowski K., Malczak P. et al. Selective vs non-selective alpha-blockade prior to adrenalectomy for pheochromocytoma: Systematic review and meta-analysis. Eur J Endocrinol. 2021. 184(6): 751–60.


https://doi.org/10.1530/EJE-20-1301. PMID: 33769959.


About the Autors

Yulia A. Katushkina, MD, endocrinologist at the Endocrinology Department, Professor S.V. Ochapovsky Research Institute – Regional Clinical Hospital No. 1, assistant at the Department of therapy Department No. 1 of the Faculty of advanced training and professional retraining of specialists, Kuban State Medical University of the Ministry of Healthcare of Russia. Address: 350901, Krasnodar, 140 Rossiyskaya St.
E-mail: ukadoc@gmail.com
ORCID: https://orcid.org/0009-0009-7334-9928
Zoya G. Tatarintseva, MD, PhD (Medicine), head of the Cardiology Department, Professor S.V. Ochapovsky Research Institute – Regional Clinical Hospital No. 1, assistant at the Department of cardiac surgery and cardiology of the Faculty of advanced training and professional retraining of specialists, Kuban State Medical University of the Ministry of Healthcare of Russia. Address: 350901, Krasnodar, 140 Rossiyskaya St.
E-mail: z.tatarintseva@list.ru
ORCID: https://orcid.org/0000-0002-3868-8061
Darya A. Flore, MD, general practitioner, cardiologist at the Surgical Department, Professor S.V. Ochapovsky Research Institute – Regional Clinical Hospital No. 1. Address: 350086, Krasnodar, 167 Pervogo Maya St.
E-mail: dasha.flore@mail.ru
Elena D. Kosmacheva, MD, Dr. Sci. (Medicine), professor, head of the of the Department of therapy Department No. 1 of the Faculty of advanced training and professional retraining of specialists, Kuban State Medical University of the Ministry of Healthcare of Russia, deputy chief physician for medical affairs, Professor S.V. Ochapovsky Research Institute – Regional Clinical Hospital No. 1. Address: 350086, Krasnodar, 167 Pervogo Maya St.
E-mail: kosmachova_h@mail.ru
ORCID: https://orcid.org/0000-0001-5690-2482
Kirill O. Barbukhatti, MD, Dr. Sci. (Medicine), professor, head of the Cardiac Surgery Department No. 2, Professor S.V. Ochapovsky Research Institute – Regional Clinical Hospital No. 1, head of the Department of cardiac surgery and cardiology of the Faculty of advanced training and professional retraining of specialists, Kuban State Medical University of the Ministry of Healthcare of Russia. Address: 350901, Krasnodar, 140 Rossiyskaya St.
E-mail: barbuhatty_k@mail.ru
ORCID: https://orcid.org/0000-0001-6403-3299


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