Haemorrhagic suprarenal pseudocysts: a systematic review of a rare condition from family physicians’ perspective during the COVID-19 global pandemic

Adel Abbas Alzehairy,Adekunle Olowu

doi:10.29245/2767-5157/2021/1.1117

Abstract

Adrenal cysts are rare lesions that could be epithelial, endothelial, parasitic or haemorrhagic[1], as well as pseudocysts. Haemorrhagic adrenal cysts are extremely rare and are often asymptomatic, so diagnosis can be really challenging. This can prove really difficult for primary care physicians who are often the frontline clinicians these patients tend to present to. They are usually benign lesions and do not often cause mortality if detected early and prompt surgery is done, as was the case with the patient in our case report[4]. When they do become symptomatic, they can present with different systemic symptoms as documented in literature, including in our case report[2,4]. Diagnosis is usually through Ultrasound and CT Scan and management is largely laparoscopic or open excision depending on the size of the lesion, surgical expertise and local protocol. Most patients make full recovery and mortality is extremely low [3]. The aim of this review is to provide a broader overview of the subject, highlight salient points in several studies relating to haemorrhagic cysts, provide an up to date follow up information on the index patient in our case report and to explore possible areas for future study [4,6]. This review also includes a suggested management algorithm and intends to emphasize the fact that patients who present in primary, urgent or emergency care settings with persistent non-specific symptoms should be investigated for rare diseases.

Highlights

The aim of this review is to provide a broader overview of the subject, highlight salient points in several studies relating to haemorrhagic cysts, provide an up to date follow up information on the index patient in our case report and to explore possible areas for future study[4,6]
This review includes a suggested management algorithm and intends to emphasize the fact that patients who present in primary, urgent or emergency care settings with persistent nonspecific symptoms should be investigated for rare diseases
In the light of the current COVID-19 pandemic that has stretched the resilience and capacities of global health services and changed the way we work, one of the greatest challenges that physicians-primary care physicians, general practitioners, endocrinologists-all over the world face is making the right diagnostic decisions for their patients, especially those who present with recurrent non-specific symptoms

Summary

Introduction

In the light of the current COVID-19 pandemic that has stretched the resilience and capacities of global health services and changed the way we work, one of the greatest challenges that physicians-primary care physicians, general practitioners, endocrinologists-all over the world face is making the right diagnostic decisions for their patients, especially those who present with recurrent non-specific symptoms. A review of 8 cases in a study in the United States revealed lesion sizes ranging from 1.8-10cm, though the size of the lesion does not correlate with symptoms, but in our case report the lesion was larger[3] They are often seen in the 5th and the 6th decades of life, but can be diagnosed during pregnancy[13,14,16]. They are relatively uncommon and rarely present with symptoms. They can cause symptoms through repeated episodes of trauma, infection or bleeding[2] When they do, they are often non-specific symptoms, for example respiratory symptoms as highlighted in our case study[4], left testicular discomfort as identified by a case report in the United Kingdom[8] and epigastric pain and abdominal distension[15]. An Indian case report even reported unusual presentations of hypertensive retinopathy, virilization and bleeding diathesis[17]

Literature Review

Olowu et al 2021 1 48

Findings

Conclusion