Adrenal artery pseudoaneurysm in pheochromocytoma presenting with catastrophic retroperitoneal hemorrhage

Abstract

Spontaneous rupture of adrenal pheochromocytoma is an extremely rare condition which presents as an abdominal catastrophe.  Unrecognized, this transformation can rapidly lead to death.  We report a case of a 63-year-old gentleman who presented with hemorrhagic shock secondary to ruptured adrenal pheochromocytoma.  The clinical course is notable for immediate trans-arterial catheter embolization (TAE) for control of bleeding, followed by optimization and elective adrenalectomy.  High mortality is associated with an operative intervention in the face of an unrecognized pheochromocytoma.  This reinforces the need for maintaining high index of suspicion in the setting of a suprarenal mass despite hypotension.