Department of General, Endocrine and Vascular Surgery, University Clinical Center of the Medical University of Warsaw, Poland.
2nd Clinic of Anesthesiology and Intensive Care, University Clinical Center of the Medical University of Warsaw, Poland.
Pol Przegl Chir. 2024 Apr 2;96(4):36-43. doi: 10.5604/01.3001.0054.4570.
<b>Introduction:</b> Adrenal hemorrhage (AH) is a very rare and potentially life-threatening disease which may be secondary to trauma or of non-traumatic etiology.<b>Aim:</b> The aim of the study was to present the characteristics and management of adrenal hemorrhage and show that adrenal hemorrhage is more common than expected and that the clinical symptoms are not specific.<b>Materials and methods:</b> This retrospective study involved 199 patients with postoperative diagnosis of adrenal hemorrhage.<b>Discussion:</b> The factors identified as potential causes of adrenal hemorrhage are adrenocortical carcinoma, pheochromocytoma, and adrenal adenoma. The study group included 199 patients with postoperative diagnosis of AH. It showed that all patients with postoperative diagnosis had pheochromocytoma (n = 54), adrenal adenoma (n = 68), or adenocarcinoma (n = 17). If we look more careful at the results, we can find only 30% of patients (n = 39) with preoperative diagnosis of AH. This group of 39 patients was prepared for expedited surgery. In this group of patients, the preoperative diagnosis of AH was pheochromocytoma 28% (n = 11), adenocarcinoma (n = 4), and adrenal adenoma (n = 9).<b>Conclusions:</b> Bleeding into adrenal tumors is still an insufficiently understood topic due to its unpredictability and, as can be seen in our material, of varying severity. Out of 199 patients, only 30% (n = 39) were prepared for surgery with a preoperative diagnosis of AH; most of them had pheochromocytoma. We suggest that is very important to prepare patients for surgery with a preoperative diagnosis of AH using α-adrenoreceptor antagonists. Prolongation of the diagnostic process (time between the imaging examination and the surgery) may result in the disease progressing and adrenal bleeding.
<b>引言：</b>肾上腺出血（AH）是一种非常罕见且可能危及生命的疾病，可能继发于创伤或非创伤性病因。<b>目的：</b>本研究旨在介绍肾上腺出血的特征和处理方法，并表明肾上腺出血比预期更为常见，且临床症状不具有特异性。<b>材料和方法：</b>本回顾性研究纳入了 199 例术后诊断为肾上腺出血的患者。<b>讨论：</b>被确定为肾上腺出血潜在原因的因素有：肾上腺皮质癌、嗜铬细胞瘤和肾上腺腺瘤。研究组包括 199 例术后诊断为 AH 的患者。结果表明，所有术后诊断为 AH 的患者均患有嗜铬细胞瘤（n = 54）、肾上腺腺瘤（n = 68）或腺癌（n = 17）。如果我们更仔细地观察结果，可以发现仅有 30%（n = 39）的患者术前诊断为 AH。这 39 例患者组准备进行急诊手术。在这组患者中，术前诊断为 AH 的患者中，嗜铬细胞瘤占 28%（n = 11），腺癌占 4%，肾上腺腺瘤占 9%。<b>结论：</b>由于其不可预测性，以及如我们的资料所示的不同严重程度，肾上腺肿瘤出血仍然是一个研究不足的话题。在 199 例患者中，仅有 30%（n = 39）的患者术前诊断为 AH 并准备进行手术；其中大多数患者患有嗜铬细胞瘤。我们建议，使用α-肾上腺素受体拮抗剂对术前诊断为 AH 的患者进行手术准备非常重要。诊断过程的延长（影像学检查与手术之间的时间）可能导致疾病进展和肾上腺出血。
