Spontaneous rupture of adrenal incidentaloma in a patient with subclinical Cushing’s syndrome, whose clinical expression is metabolic syndrome

A 68-year-old female with enlarged bilateral adrenal glands who was being monitored for metabolic syndrome (MetS) and subclinical Cushing’s syndrome was admitted to our hospital because of rupture of the left adrenal gland. We performed abdominal aortography and embolization of the left middle adrenal artery, and the patient’s pain resolved soon afterwards. After the left adrenal rupture, endocrinological studies still showed subclinical Cushing’s syndrome, and she exhibited no changes in the metabolic disorders. Because she refused removal of the left adrenal gland, we observed her clinical course carefully. One year after the adrenal gland rupture, abdominal computed tomography revealed complete absorption of the retroperitoneal hemorrhage and 131 I-adosterol scintigraphy showed a similar result to that previously found. Although adrenal rupture is a rare condition, we should be aware of its possibility during the follow-up of incidental adrenal tumors. Subclinical Cushing’s syndrome has many common features with lifestyle diseases, such as excessive visceral fat, hypertension, metabolic disorders of glucose and lipids. Careful examinations are needed to follow up many patients with lifestyle-related diseases or MetS for a long period.