International Urology and Nephrology 32: 291–292, 2000. © 2000 Kluwer Academic Publishers. Printed in the Netherlands. 291 Spontaneous regression of bilateral surrenal haematoma and subclinical hypoaldosteronism in a patient with renal amyloidosis secondary to Familial Mediterranean Fever O. Kara & S. Payda¸ s Çukurova University, Faculty of Medicine, Department of Internal Medicine, Adana, Turkey Abstract. This report describes a patient with Familial Mediterranean Fever (FMF) associated with renal amyloidosis, bilaretal surrenal haematomas and hypoaldosteronism which was clinically asymptomatic. The deposition of AA amyloide was found on the renal and bone marrow biopsies. Bilateral surrenal haematoma regressed after six month from the first events. Colchicine therapy controlled the attacks of the disease. Key words: Familial Mediterranean, Surrenal haematoma Introduction Familial Mediterranean Fever is an autosomal recess- ive disorder which is characterized by recurrent epis- odes of polyserositis and fever. Bleeding disorder is mainly due to perivascular amyloid deposition and increased vascular fragility [6], such as petechiae, ecchymoses, gastrointestinal and urinary tract bleed- ing. Surrenal haematoma, especially bilaterally, has not been reported in the English literature. Although there was bilateral surrenal haematoma, subclinical hypoaldosteronism was found. After six months the haematoma regressed. Colchicine therapy controlled the attacks of the disease. Case report A 38 years old woman was admitted because of nausea, vomiting and abdominal pain. For 10 years she had been suffering from periodic abdominal and fever attacks (39–40 ◦ C). She was operated on with the diagnosis of appendicitis at 5 years of age and had right oophorectomy at 26 years of age and had ovarian cystectomy at 37 years of age. In recent months, she had had frequent episodes of pain lasting for 3–4 days periodically, with nausea and vomiting. The patient had smoked one pack of cigarettes daily for 20 years. On admission, she was pale and dehydrated, then temperature was 36 ◦C, pulse rate was 80/min, res- piratory rate was 22/min and the blood pressure was 100/60 mmHg. Physical examination was normal except for epigastric tenderness, incisions of 6 cm and 3 cm in the suprapubic and right lower quadrants, respectively. Bowel peristaltic sounds were 4–6/min. Laboratory findings: urinary specific gravity 1005, pH 6.5, Eschbach 0.3 g/lt. Haemoglobin. 10.2 g/dl, WBC 11.5 × 10/ml, platelet count 414.000/mlt. ESR was 127 mm in hour. BUN 55 mg/dl, serum creatinine 7.3 mm/dl ALT 25 U/l AST 30u/lt LDH 719 U/l, ALP 424 u/l serum total protein 5.6 g/dl serum albu- min 2.4 g/dl serum Ca 7.4 mg/dl and P 4.7 mg/dl, serum iron 33 mg/dl, TIBC (Total Iron Binding Capacity) 102 mg/dl, 69 mg/dl. Hypochromical in erythrocytes and neutrophilia without toxic granula- tion were found on blood smear, PT (prothombin time) 15s (INR: 1.37), PTT (Partial thromboplastin time): 30s fibrinogen 419 mg/dl, coagulation time 5 minutes and bleeding time was 1.5 minutes ANF (antinuclear factor), RF (rheumatoid factor) and Anti- ds DNA in serum were negative. Alpha (27%) and beta (13.7%) fractions of globulin on protein electro- phoresis were increased, Bence-Jones proteinuria was found. Abdominal ultrasonography revealed increased renal dimension and parenchymal echogenicity. Addi- tionally bilateral surrenal mass thought to be a haemat- oma was found on CT (dimension about 3 cm on the right and 2,5 cm on the left surrenal glands). While rectal biopsy and subcutaneous fat aspiration were