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+A 68-year-old man, with a history of upper gastrointestinal haemorrhage due to aspirin and transient ischaemic accident under chronic treatment with trifusal (300 mg every 12 hours), attended the emergency department of the Hospital San Agustín (Avilés, Asturias) in May 2006, due to intense, continuous, sudden onset pain in the left hemiabdomen accompanied by vegetative crusade. On examination, blood pressure was 210/120 mm Hg, heart rate 80 per minute, and pain in the left iliac fossa, accentuated by palpation. The blood count (haemoglobin: 13 g/dL, platelets: 249,000), coagulation study, elementary blood biochemistry, urine system, electrocardiogram and simple chest X-ray were normal. The abdominal CT scan showed an extensive haematoma, 12 cm in maximum diameter, in the left renal cell, with no free intraperitoneal fluid; the left adrenal gland was engulfed and could not be identified, and the right adrenal gland was unchanged. The AHT was not controlled in the ED, despite treatment with analgesics, calcium antagonists and angiotensin II-converting enzyme inhibitors, so the patient, who maintained blood pressure levels of 240/160 mm Hg, was transferred to the Intensive Care Unit for intravenous treatment with nitroprusside and labetalol. In the following 24 hours, the hypertensive crisis was jugulated, and haemoglobin and haematocrit were found to remain stable.
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+With the diagnostic suspicion of non-traumatic rupture of a pre-existing pheochromocytoma, plasma metanephrines were determined, which were normal, and urinary catecholamines and metanephrines. In the 24-hour urine of the day after admission, the following results were obtained: adrenaline: 65.1 mcg (normal values - VN: 1.7-22.5), noradrenaline: 151.1 mcg (VN: 12.1-85.5), metanephrine: 853.5 mcg (VN: 74-297) and normetanephrine: 1396.6 mcg (VN: 105-354). After 10 days, while the patient was still in hospital, the urinary figures had completely normalised spontaneously.
+As for the haematoma, in July 2006 it had not been reabsorbed and a pseudocystic image persisted in the left adrenal area. A unilateral adrenalectomy was performed in September 2006, and histological examination showed an encapsulated mass measuring 6 x 5 cm, with extensive haemorrhagic necrosis and some cortical cells without atypia.
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