Unusual clinical presentation and complications following preoperative embolization of a large adrenal tumor

Puneet Garg, Ankita Aggarwal, Venkatram Krishnan, Sunil Kumar Bajaj, Ritu Nair Misra


Authors present a case of a young female presenting with secondary amenorrhea which on further investigation revealed a large intra-abdominal mass, likely arising from the left adrenal gland. As the tumor was highly vascular with large feeders, she was referred for pre-operative embolization to reduce the blood loss during surgery. Post embolization, the patient suffered from an unusual complication of tumor rupture along with excessive secretion of catecholamines resulting in myocarditis and myocardial infarction. Patient ultimately died of the myocardial infarction. Preoperative embolization of a large, hypervascular adrenal mass lesion is not devoid of unusual complications like tumor rupture and subsequent cardiovascular complications even if the tumor is hormonally inactive. This complication is extremely rare and has never been reported in adrenal tumors after embolization.


Catecholamines, Embolization, Myocardial infarction, Pheochromocytoma, Rupture

Full Text:



Wakil A, Atkin S. Secondary amenorrhoea due to pheochromocytoma: a case report. Cases J. 2008;1(1):30.

Ramsay JA, Asa SL, Van Nostrand AW, Hassaram ST, de Harven EP. Lipid degeneration in pheochromocytomas mimicking adrenal cortical tumors. Am J Surg Pathol. 1987;11(6):480-6.

Prabhasavat K, Ruamcharoenkiat S. Outcomes of Arterial Embolization of Adrenal Tumor in Siriraj Hospital: Case Report. J Med Assoc Thai. 2015;98(6):621-7.

Merklin RJ, Michels NA. The variant renal and suprarenal blood supply with data on the inferior phrenic, ureteral and gonadal arteries: a statistical analysis based on 185 dissections and review of the literature. J Intern Colleg Surg. 1958;29(11):41.

Pua U, Wong DE. Transarterial embolisation of spontaneous adrenal pheochromocytoma rupture using polyvinyl alcohol particles. Singapore Med J. 2008;49(5):126-30.

Bunuan HD, Alltree M, Merendino KA. Gel foam embolization of a functioning pheochromocytoma. Am J Surg. 1978;136(3):395-8.

Hrabovsky EE, McLellan D, Horton JA, Klingberg WG. Catheter embolization: preparation of patient with pheochromocytoma. J Pediatr Surg. 1982;17(6):849-50.

Ali AM, Devbhandari M, Sastry A, Ashleigh RJ, Jones MT. Preoperative embolization followed by surgical excision of an intrapericardial pheochromocytoma. Annals Thorac Surg. 2007;83(1):302-4.

Di Daniele N, Canale MP, Tesauro M, Rovella V, Gandini R, Schillaci O, et al. Preoperative embolization reduces the risk of cathecolamines release at the time of surgical excision of large pelvic extra-adrenal sympathetic paraganglioma. Case Rep Endocrinol. 2012;2012:481328.

Forty J. Ruptured Phaeochromocytoma: a case report. JR Coll Surg Edinb. 1989;34(2):109-10.

Mok FP. Ruptured phaeochromocytoma lesson in acute abdomen. Hong Kong Med J. 2003;9(3):221-3.

Marti JL, Millet J, Sosa JA, Roman SA, Carling T, Udelsman R. Spontaneous adrenal hemorrhage with associated masses: etiology and management in 6 cases and a review of 133 reported cases. World J Surg. 2012;36(1):75-82.

Van Way 3rd CW, Faraci RP, Cleveland HC, Foster JF, Scott Jr HW. Hemorrhagic necrosis of pheochromocytoma associated with phentolamine administration. Annals Surg. 1976;184(1):26.

Habib M, Tarazi I, Batta M. Arterial embolization for ruptured adrenal pheochromocytoma. Curr Oncol. 2010;17(6):65.

Charon P, Hamwi A, Laigneau P, Beroud P. Pseudo-coronary form of haemorrhagic rupture of a pheochromocytoma: about an observation. In Ann Cardiol Angeiol. 1991;40(4):193-7.