Adrenal Hemorrhage as a Presenting Symptom in a Patient with Undiagnosed Cushing syndrome: A Case Report

Abstract

Introduction: Spontaneous adrenal hemorrhage is a rare occurrence, often associated with trauma or underlying adrenal pathology. It poses a diagnostic challenge due to its nonspecific presentation and rarity. Adrenal hemorrhage as an initial presentation of Cushing syndrome is particularly uncommon. [1]
Case Presentation: A 23-year-old Saudi male with no significant medical history, except for prior gastric sleeve surgery, presented with sudden-onset left flank pain. Imaging revealed a left adrenal hemorrhage and further workup identified ACTH-independent Cushing syndrome secondary to adrenal cortical hyperplasia. The patient underwent a successful laparoscopic adrenalectomy, with histopathology confirming adrenal cortical hyperplasia with hemorrhage.
Discussion: Adrenal hemorrhage is rarely the initial manifestation of Cushing syndrome, with most cases typically associated with trauma or coagulopathy. [2] In this case, the patient presented with spontaneous hemorrhage and was later diagnosed with Cushing syndrome, which contributed to the adrenal pathology. Persistent obesity post-gastric sleeve surgery added complexity to the case, highlighting the need for thorough endocrine evaluation.
Conclusion: This case illustrates the diagnostic challenges of spontaneous adrenal hemorrhage and its association with underlying Cushing syndrome. A multidisciplinary approach, including conservative management and elective surgery, ensured successful patient outcomes. Early diagnosis and treatment are critical in preventing life-threatening complications in similar cases.