What is the incidence of hemorrhage from adrenal biopsy?

From the Guidelines

The incidence of hemorrhage from adrenal biopsy is estimated to be around 8-12% based on complication rates reported in the literature. Adrenal glands are highly vascular organs, which contributes to this bleeding risk. The risk is higher for certain patient populations, such as those with pheochromocytomas, due to the hypervascular nature of these tumors 1.

Key Considerations

• The accuracy of biopsy is 96% to 100% for malignant lesions, but biopsy interpretation is more difficult in benign processes 1.
• Complication rates, including bleeding, pneumothorax, infection, and anecdotes of tumor tracking, range from 8% to 12% 1.
• Several deaths have been reported after adrenal biopsies of pheochromocytomas, highlighting the importance of careful patient selection and preparation 1.

Minimizing Bleeding Complications

• Patients should discontinue anticoagulants and antiplatelet medications 5-7 days before the procedure when possible.
• Blood pressure should be optimized before the procedure, especially in patients with suspected pheochromocytoma who should receive alpha-blockade pretreatment.
• The use of smaller gauge needles (20-22G) and limiting the number of needle passes can reduce bleeding risk.
• Post-procedure, patients should be monitored for at least 4-6 hours, with vital sign checks every 15-30 minutes for the first two hours.

Monitoring and Intervention

• A sudden drop in blood pressure or increasing abdominal pain may indicate hemorrhage requiring immediate intervention.
• Patients with pheochromocytomas have an increased risk of hemorrhage (up to 7-10%) due to the hypervascular nature of these tumors, and should be closely monitored 1.

From the Research

Incidence of Hemorrhage from Adrenal Biopsy

• The incidence of hemorrhage from adrenal biopsy is not directly reported in the provided studies, but some studies mention the risk of hemorrhage associated with adrenal lesions or biopsy procedures 2, 3.
• A study on adrenal biopsy guided by ultrasound and CT reported 3 cases of hematoma out of 56 patients, but it does not specify whether these hematomas were caused by the biopsy procedure itself 2.
• Another study on fine-needle aspiration biopsy of adrenal gland lesions does not mention the incidence of hemorrhage as a complication of the procedure 3.
• Studies on adrenal hemorrhage (AH) report that it can occur due to various etiologies, including trauma, sepsis, coagulopathy, and underlying neoplasms 4, 5, 6.
• The incidence of AH is reported to be 0.11% in a study of 490,301 imaging reports, with most cases being diagnosed incidentally on imaging 6.

Risk Factors for Hemorrhage

• The risk factors for adrenal hemorrhage include focal adrenal lesion, abdominal trauma, and anticoagulation therapy 4.
• Other reported risk factors for AH include septicemia, coagulopathy or bleeding diathesis, and underlying neoplasms 5.
• COVID-19 and neonatal stress are also reported as less common causes of AH 5.

Diagnosis and Management

• The diagnosis of AH is often challenging due to its non-specific presentation and occurrence in the setting of acute medical illness 5.
• Imaging modalities such as CT and ultrasound are used to diagnose AH, and follow-up imaging is necessary to reassess the lesion 4, 6.
• The management of AH depends on the severity of the condition and the presence of underlying neoplasms, with some cases requiring surgical intervention and others being managed conservatively 4, 6.