Adrenal hemorrhage: A single center experience and literature review

Abstract

Background. Adrenal hemorrhage (AH) is a rare condition that can lead to acute adrenal insufficiency and may be fatal. The risk factors of AH include focal adrenal lesion, abdominal trauma and anticoagulation therapy. The clinical manifestation of AH varies widely; the symptoms may be related to adrenal insufficiency or may reflect multiple organ failure. However, in many cases, the course of AH is asymptomatic. Objectives. The study is a retrospective analysis of 23 cases of AH, whose aim is to discuss the etiology and the management of selected patients, as well as a literature review. Material and methods. The paper presents a retrospective analysis of 23 patients with AH confirmed by radiological and/or pathological examination. Epidemiological data, the results of laboratory tests, and radiological and pathological examinations were included in the analysis. Results. The risk factors of AH were not established in 13 patients, 5 patients had experienced a trauma prior to AH diagnosis, 1 patient was diagnosed with sepsis, 2 patients had concomitant neoplastic disease, and in 2 patients, 2 risk factors were present. Among patients who required emergency admission, 5 patients were hospitalized due to acute abdominal pain, 1 patient due to sepsis and 1 patient due to symptoms of active endocrinopathy. In the remaining patients, diagnostic procedures were prompted by the detection of adrenal incidentaloma (AI). A total of 40% of patients underwent surgical treatment due to the magnitude of AH or clinical and laboratory evidence of overt endocrinopathy. In the remaining patients, conservative treatment and further observation was recommended. In 34.8% of these patients, follow-up examinations revealed a gradual regression. Conclusions. It seems that there is a need to distinguish patients with AH who do not require surgical intervention. Follow-up radiological examination is necessary to reassess the lesion. The patients in whom shrinkage of the tumor can be observed are likely not to require surgical treatment.

Waterhouse–Friderichsen syndrome in a cat with Klebsiella spp. infection

“…Suggested criteria for antemortem diagnosis are evidence of bilaterally enlarged and hyperdense adrenal glands on CT and demonstration of adrenocortical failure on hormonal evaluation. 7,8 In the majority of cases, Waterhouse-Friderichsen syndrome is only identified at necropsy due to rapid progression of signs resulting in hypotension and cardiac arrest. 3 Necropsy findings of cases with Waterhouse-Friderichsen syndrome include gross identification of massive adrenal hemorrhage and microscopic findings of hemorrhages localized to the corticomedullary junction and infarction of the cortex.…”

“…Antemortem findings of acute adrenal hemorrhage in people include abdominal pain, pyrexia, and endocrinopathies. Suggested criteria for antemortem diagnosis are evidence of bilaterally enlarged and hyperdense adrenal glands on CT and demonstration of adrenocortical failure on hormonal evaluation 7,8 . In the majority of cases, Waterhouse–Friderichsen syndrome is only identified at necropsy due to rapid progression of signs resulting in hypotension and cardiac arrest 3 .…”

Hemorrhagic Adrenal Myelolipoma after Trauma to Left Adrenal Gland: A Case Report

“…[11,15] The most frequent presentation of traumatic adrenal injury is an oval hematoma encasing the adrenal gland. [7,14,16] Intraparenchymal hematomas and bulky adrenal glands with or without extravasation were also reported. [14] In the current case, extravasation observed by contrast CT was accompanied by a decrease in hemoglobin.…”

“…[19] However, most patients with myelolipoma are treated conservatively. [4][5][6]10,16] Traumatic adrenal injury is an unusual presentation of adrenal myelolipoma. Although it is incidentally found in less than 5% of all abdominal blunt injuries, adrenal myelolipoma should be considered in patients presenting with bleeding and a history of trauma to the flank to provide the necessary prompt treatment.…”

Vanishing of ruptured adrenal mass with takotsubo cardiomyopathy

“…Therefore, we cannot rule out the possibility that our patient experi-enced rupture of the cortisol-secreting adrenal adenoma. Anyway, there is no reported case of the vanishing adrenal mass in association with adrenal infarction, adrenal haemorrhage, and Cushing's syndrome [9][10][11].…”