SUN-418 Spontaneous Adrenal Hemorrhage in a 39-Year-Old Female: A Case Report

Abstract Disclosure: M. Eldib: None. N. Fretes Oviedo: None. P.P. Rao: None. Introduction: Spontaneous adrenal hemorrhage is a rare but potentially life-threatening condition, often presenting with nonspecific symptoms such as abdominal pain and malaise. Prompt diagnosis and management are crucial to prevent complications, including adrenal insufficiency. While various etiologies have been associated with adrenal hemorrhage, including trauma, anticoagulant therapy, and underlying adrenal tumors, cases without clear precipitating factors pose diagnostic challenges. Case Presentation: A 39-year-old female with a history of asthma and iron deficiency anemia presented with sudden-onset right-sided abdominal pain. CT with IV contrast revealed a 5.4 × 6.9 cm hemorrhage with active extravasation in the right adrenal gland. Laboratory tests showed elevated plasma metanephrine (227 pg/mL; ref 16-67) and normetanephrine (2,380 pg/mL; ref 18-101). BP was 132/76 mm Hg, pulse 114 bpm. Adrenal arteriography confirmed active bleeding from a right adrenal artery branch, which was successfully embolized. Postoperatively, the patient remained hemodynamically stable. Follow-up labs showed normalized plasma metanephrine (81 pg/mL) and normetanephrine (256 pg/mL), with normal ACTH, cortisol, plasma renin (3.9 ng/mL/hr), and aldosterone levels. A dexamethasone suppression test confirmed inappropriate cortisol suppression (post-test cortisol: 2.7 µg/dL). One-month follow-up CT without IV contrast revealed a stable 7.3 × 4.7 cm lesion in right adrenal, consistent with hematoma, with adjacent embolization coils and no signs of re-bleeding. Discussion: Spontaneous adrenal hemorrhage without identifiable precipitating factors is uncommon. In this case, the absence of trauma, anticoagulant use, or significant comorbidities suggests a spontaneous etiology. Early intervention can prevent complications such as adrenal insufficiency and reduce the need for surgical exploration. Conclusion: This case emphasizes the need to consider spontaneous adrenal hemorrhage in the differential diagnosis of acute abdominal pain, even when common risk factors are absent. And in this case, it remains elusive. Timely diagnosis and appropriate management can result in favorable outcomes. Further studies are warranted to better understand the risk factors and long-term outcomes of this uncommon condition. Presentation: Sunday, July 13, 2025