This report has the objective of highlighting adrenal haemorrhage as a presenting feature of adrenocortical carcinoma (ACC) and stressing the importance of close follow-up and thorough initial investigation of adrenal nodules to ascertain their underlying aetiology and ultimately prevent delay to appropriate management.
Adrenocortical carcinomas (ACC) are a very rare entity with an incidence of approximately 0.5 to 2 cases per million per year (1). They are often difficult to diagnose clinically, attributing to non-specific signs and symptoms especially with non-functioning tumours, with histopathology required for confirmatory diagnosis. Atraumatic adrenal haemorrhage has been described in the literature as a rare presentation of ACC.
We describe a case of a gentleman in his 50s presenting with acute spontaneous unilateral adrenal haemorrhage on a background of a pre-existing known incidental adrenal nodule that was lost to follow-up. The patient underwent angio-embolisation and subsequent laparoscopic adrenalectomy, with histopathology demonstrating ACC.
Our case mirrors that of existing studies with high attrition rates and stresses the need for judicious follow-up of adrenal incidentalomas. All adrenal nodules require exclusion of hormonal excess and dedicated adrenal imaging, with provision of clear plans to primary health practitioners if investigations are not completed in the inpatient setting.