SAT-440 Unilateral Adrenal Hemorrhage in a Patient on Anticoagulation for Atrial Fibrillation: A Rare Case

Abstract Disclosure: M. Lopez Baez: None. C. Sanchez Perez: None. Y. Goldman Gollan: None. M. Duchow: None. S. Hanson-Leal: None. Adrenal hemorrhage is a rare complication, often linked to anticoagulation, trauma, or coagulopathies, and can present significant diagnostic and management challenges. We report the case of a 71-year-old female with paroxysmal atrial fibrillation (AF) who developed acute right upper quadrant pain five days after initiating apixaban. Imaging revealed a 5.5 cm hemorrhagic mass in the right adrenal gland, consistent with unilateral adrenal hemorrhage. Initial laboratory studies showed no evidence of adrenal insufficiency, a finding consistent with most cases of unilateral adrenal hemorrhage. Computed tomography angiography confirmed the hemorrhage without active extravasation. The patient had a prior history of a right adrenal incidentaloma, previously evaluated with a 24-hour urine test that was negative for hormonal hypersecretion. Anticoagulation was held, and she was managed with multimodal pain control, fluid resuscitation, and close monitoring of hemoglobin. General surgery recommended non-operative management. Further evaluation revealed normal catecholamine levels and tumor markers, ruling out functional adrenal pathology. Follow-up imaging demonstrated a size reduction of the adrenal hematoma to 3.3 cm. After stabilization and confirmation of no active bleeding, anticoagulation was resumed. This case underscores the rarity of unilateral adrenal hemorrhage in patients initiating anticoagulation therapy and highlights the diagnostic complexities in distinguishing spontaneous hemorrhage from functional adrenal masses or malignancies. A multidisciplinary approach involving endocrinology, surgery, and cardiology ensured timely recognition, tailored management, and favorable outcomes. Maintaining a high index of suspicion for adrenal hemorrhage in patients with acute abdominal pain and recent anticoagulant use is critical, as prompt intervention can prevent life-threatening complications. The successful resolution of this case emphasizes the importance of close monitoring, collaboration across specialties, and careful evaluation of the risks and benefits of anticoagulation resumption. Presentation: Saturday, July 12, 2025