Anastomosing hemangioma of the adrenal gland as culprit of persistent hypertension in a 29 year old male patient: A case report

Introduction Anastomosing hemangioma is a rare benign vascular tumor. Since its initial description, only a few cases have been reported in the literature. The adrenal gland is among the rarest locations for this tumor. These benign lesions are most often seen in patients in their fifth or sixth decades of life. Anastomosing hemangiomas are usually asymptomatic, and their diagnosis is often incidental during imaging performed for other reasons. Hypertension due to compressive mass effect from both malignant and benign lesions of the adrenal glands or kidneys has been reported in case studies. However, anastomosing hemangioma as a cause of persistent hypertension in young individuals has not been previously described. To the best of our knowledge, this is the first reported case of an adrenal anastomosing hemangioma causing persistent hypertension. Case presentation A 29-year-old male presented with a complaint of epigastric swelling of 20 years' duration, which had worsened over the past four years and became particularly bothersome one week prior to presentation. He also had a history of hypertension for the past two years, managed with three antihypertensive medications and lifestyle modifications; however, his blood pressure remained uncontrolled. An abdominal ultrasound was performed to evaluate the epigastric swelling, revealing a right adrenal mass. A subsequent contrast-enhanced computed tomography (CT) scan was obtained for better characterization, which showed an avidly enhancing right adrenal mass with central necrosis. Differential diagnoses included lipid-poor adenoma and pheochromocytoma. Due to the unavailability of percutaneous biopsy, surgical excision was planned. A simple right adrenalectomy was performed, and the specimen was sent for histopathologic evaluation. The patient recovered from surgery without complications. Histopathology revealed an anastomosing hemangioma. During follow-up at the outpatient department, the patient's blood pressure normalized, and he was subsequently discharged. Conclusion Anastomosing hemangioma of the adrenal gland is one of the rarest locations for this benign vascular tumor. The diagnosis is often incidental. In young patients presenting with persistent hypertension, secondary causes should always be considered. Although benign masses causing hypertension due to a mass effect are rare, they have been reported in the literature. Surgical excision is recommended to correct the blood pressure before end-organ damage occurs.