Spontaneous adrenal hemorrhage after rupture of adenoma: case report and review of 78 cases

Introduction: Spontaneous adrenal hemorrhage (SAH) in the absence of trauma or anticoagulant therapy is rare. This entity presents an insidious clinical picture, making diagnosis difficult and treatment challenging. We present a case of SAH and a review of 78 related cases. Case presentation: A 32-year-old previously healthy woman presented with sudden, severe lower back pain and nonspecific symptoms resembling a urinary tract infection. After imaging studies, an SAH was detected. Due to persistent hemorrhage and abdominal tenderness, she underwent emergency surgical treatment, which showed a ruptured adrenal capsule caused by an adrenal tumor. Malignancy was ruled out, and an adrenal adenoma was identified as the cause. Our review of 78 cases of SAH found a predominance in men ( n = 33, 53%) with unilateral hemorrhage ( n = 57, 86%). The leading etiology was primary adrenal tumors ( n = 26, 40%), and most cases were treated with adrenalectomy. The overall mortality rate was 8%. Clinical discussion: This case highlights the importance of recognizing SAH as a differential diagnosis in patients with atypical clinical presentations. Furthermore, it highlights the importance of early detection, the necessity of timely surgical intervention, and the need for close follow-up to assess adrenal function and monitor clinical progress. Conclusions: SAH is a rare and potentially life-threatening condition. It can present as a surgical emergency and may be caused by an adrenal adenoma. Early identification is crucial to prevent complications.