Emergency embolisation of acute adrenal gland haemorrhages due to underlying neoplasms - multicentre experience and literature overview.

Purpose: Acute adrenal haemorrhage is a rare occurrence caused most commonly by trauma or ruptured neoplasms. In the case of the latter, rapid adrenal tumour growth resulting in elevated intracapsular pressure leads to capsular tear and massive retroperitoneal bleeding. Endovascular embolisation has been reported as a successful and safe method of treatment in selected patients. The aim of this paper was to report multicentre experience with endovascular treatment of patients presenting with acute adrenal gland haemorrhages caused by neoplasms. Material and methods: This is a multi-centre retrospective study focusing on patients treated by endovascular embolisation because of malignant adrenal haemorrhages in an acute setting from 2012 to 2024. Results: In total, 13 patients (10 men and 3 women, mean age: 65.4 years) were included in the study. All subjects presented with neoplastic haemorrhages - 8 presented with adrenal metastasis and 5 were primary neoplasms. In all cases a contrast-enhanced computed tomography confirmed the bleeding. Procedures were performed under local anaesthesia via femoral access. Embolic agents were adopted according to the type of vessel lesion and operator preference. Technical success, defined as cessation of adrenal bleeding detectable at control angiography, was 100%; 1 patient required a second embolisation after 24 hours due to recurrence. Clinical success considered as haemodynamic stability and clinical improvement was obtained in 85% (11/13 patients). No major complications were observed. Conclusions: Malignant acute adrenal haemorrhages can be safely and effectively treated with endovascular means after thorough and careful anatomical examination of the arterial supply.