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Adrenal Hemorrhage Clinical Presentation

  • Author: Nicholas A Tritos, MD, DSc, MMSc, FACP, FACE; Chief Editor: George T Griffing, MD  more...
Updated: Jul 05, 2016


Symptoms of adrenal hemorrhage are nonspecific; they include abdominal, lumbar, pelvic, or thoracic pain and symptoms of acute adrenal insufficiency, such as fatigue, anorexia, nausea, and vomiting. Symptoms associated with the underlying condition(s) also may be present. Rarely, adrenal hemorrhage is entirely asymptomatic, presenting as an incidental finding on imaging studies.

Pain that is nonspecific in location and quality is the most consistent feature of adrenal hemorrhage.

  • Nonspecific pain occurred in 65-85% of published cases.
  • It can occur predominantly in the epigastrium, flank, upper or lower back, pelvis, or precordium or elsewhere in the thorax.
  • Left shoulder pain may occur in association with abdominal pain, likely because of diaphragmatic irritation.

Fatigue, weakness, dizziness, arthralgias, myalgias, anorexia, nausea, vomiting, and diarrhea, which are present in approximately 50% of extensive, bilateral adrenal hemorrhage cases, are indicative of acute adrenal insufficiency.

Symptoms of the underlying condition(s) predisposing to adrenal hemorrhage may be present. For example, patients with Waterhouse-Friderichsen syndrome often experience prodromic, nonspecific symptoms, including malaise, headache, dizziness, cough, arthralgias, and myalgias.

Adrenal hemorrhage may be present in approximately 2 of 1000 newborn infants and may arise spontaneously or in association with birth trauma, asphyxia, sepsis, or hemorrhagic diathesis.



Physical findings in patients with adrenal hemorrhage are nonspecific and vary depending on the extent of adrenal hemorrhage, the bleeding rate, and the underlying cause, as well as according to whether the adrenal hemorrhage is bilateral or unilateral.

Fever (ie, temperature >38ºC) is present in 50-70% of patients with adrenal hemorrhage, representing the most frequent finding in adrenal hemorrhage.

  • In reported cases, temperature may range from low-grade fever to high fever with chills.
  • In the setting of adrenal hemorrhage, fever may be associated with adrenal insufficiency, the hematoma itself, or the underlying cause of adrenal hemorrhage.

Tachycardia has been reported in approximately 40-50% of patients early in the course of extensive, bilateral adrenal hemorrhage, and without aggressive therapy, it may progress to shock.

Orthostatic hypotension is present in approximately 20% of patients with extensive, bilateral adrenal hemorrhage. This is an early finding that, if there is no specific intervention, usually leads to supine hypotension and shock.

Because shock occurs only late in the course of extensive, bilateral adrenal hemorrhage, its absence should not be used to exclude this diagnosis.

  • In addition to acute adrenal insufficiency, shock in patients with extensive, bilateral adrenal hemorrhage may be caused by 1 or more underlying conditions, including sepsis, cardiovascular causes (commonly myocardial infarction and pulmonary embolism), or hypovolemia.
  • In Waterhouse-Friderichsen syndrome, activation of several cytokine mediators appears to lead to sepsis and shock. Whether acute adrenal insufficiency has a significant role in the pathogenesis of the Waterhouse-Friderichsen syndrome remains unclear and debatable.

Hypertension has been reported rarely in patients with unilateral adrenal hemorrhage; in one patient it was accompanied by headache and dizziness, leading to an erroneous diagnosis of pheochromocytoma.

Weight loss is very uncommon, but it may occur in cases of adrenal hemorrhage that are recognized several weeks after the event. These patients have a subacute presentation of adrenal insufficiency in association with adrenal hemorrhage, instead of acute adrenal crisis.

Skin hyperpigmentation has been reported rarely in adrenal hemorrhage cases. Its presence indicates late recognition of adrenal insufficiency in association with adrenal hemorrhage.

A characteristic skin rash with a typical evolution occurs in approximately 75% of patients with Waterhouse-Friderichsen syndrome.

  • In its early stages, the rash consists of small, pink macules or papules.
  • These are rapidly followed by petechial lesions, which gradually transform into large, purpuric, coalescent plaques in late stages of the disease.

Signs of acute abdomen, including guarding, rigidity, or rebound tenderness, have been reported in 15-20% of patients. This relative paucity of physical findings on abdominal examination is likely secondary to the retroperitoneal location of the adrenals.

Confusion and disorientation are present in 20-40% of patients. These findings are also nonspecific, because they may be associated with acute adrenal insufficiency or with the underlying condition(s) precipitating adrenal hemorrhage.



In at least 50% of cases, bilateral adrenal hemorrhage is associated with an acute, stressful illness (eg, infection, congestive heart failure, myocardial infarction, complications of pregnancy) or event (eg, surgery or invasive procedure). Other frequent associations include hemorrhagic diatheses (eg, anticoagulant use, thrombocytopenia), thromboembolic disease (including antiphospholipid antibody syndrome), blunt trauma, and ACTH therapy. In addition, bilateral adrenal hemorrhage has been reported in patients with tuberculosis, amyloidosis, or metastatic tumors involving the adrenals, including lung adenocarcinoma. A multicenter, hospital-based, case-control study identified thrombocytopenia, heparin exposure, and sepsis as the major risk factors for the development of bilateral adrenal hemorrhage.

  • Infections associated with extensive, bilateral adrenal hemorrhage are diverse; they include sepsis, wound infections, pneumonia, pseudomembranous colitis, influenza, varicella, and malaria.
  • Waterhouse-Friderichsen syndrome (purpura fulminans) represents hemorrhagic necrosis of several organs, including adrenal hemorrhage, in the setting of overwhelming sepsis. The syndrome frequently is characterized by a distinctly hemorrhagic skin rash. Although Waterhouse-Friderichsen syndrome originally was recognized in association with meningococcal disease, which still accounts for 80% of cases, the syndrome also has been associated with other bacterial pathogens, including Streptococcus pneumoniae, group A beta-hemolytic streptococci, Neisseria gonorrhoeae, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae (group B), Salmonella choleraesuis, Pasteurella multocida, Acinetobacter calcoaceticus, and Plesiomonas shigelloides. [4]
  • Congestive heart failure, myocardial infarction, inflammatory bowel disease, acute pancreatitis, and cirrhosis also have been associated with bilateral adrenal hemorrhage. [5]
  • Obstetric causes of bilateral adrenal hemorrhage include toxemia of pregnancy, spontaneous abortion, antepartum or postpartum hemorrhage, twisted ovarian cyst (in pregnancy), and primary antiphospholipid antibody syndrome. Spontaneous adrenal hemorrhage during pregnancy has rarely been described.
  • Coronary artery bypass graft surgery, hip joint replacement, intracranial surgery, and hepatic arterial chemoembolization are procedures associated with bilateral adrenal hemorrhage. [6] Heparin-induced thrombocytopenia may predispose to adrenal hemorrhage in some of these patients.
  • Hemorrhagic diatheses, including anticoagulant use, thrombocytopenia, and vitamin K deficiency have been associated with approximately one third of bilateral adrenal hemorrhage cases. Heparin use accounts for the majority of cases of anticoagulant-associated, bilateral adrenal hemorrhage. In such cases, bilateral adrenal hemorrhage occurs despite the fact that the activated partial thromboplastin time is almost invariably therapeutic, and adrenal hemorrhage represents an isolated event without evidence of bleeding elsewhere. Heparin-induced thrombocytopenia (HIT) was found to underlie several bilateral adrenal hemorrhage cases, although the precise role of HIT in the pathogenesis of heparin-induced adrenal hemorrhage has not been fully elucidated. [7]
  • Arterial (eg, pulmonary embolism, cerebrovascular disease, peripheral arterial embolism) and venous (eg, deep venous thrombosis, superficial thrombophlebitis) causes have been associated with bilateral adrenal hemorrhage in one third of cases. Antiphospholipid antibody syndrome (either primary or secondary to systemic lupus erythematosus) has been associated with bilateral adrenal hemorrhage. [8, 9, 10]
  • Blunt trauma of diverse etiologies, ranging from motor vehicle accidents to a truck ride over a bumpy road, has been associated with bilateral adrenal hemorrhage.
  • Underlying adrenal pathologic conditions, including granulomatous diseases, amyloidosis, and metastatic cancer (eg, lung or gastric adenocarcinoma), have been associated with bilateral adrenal hemorrhage.
  • Treatment with ACTH for multiple sclerosis or inflammatory bowel disease has in some cases been associated with bilateral adrenal hemorrhage.

Unilateral adrenal hemorrhage most frequently is caused by blunt abdominal trauma (traumatic adrenal rupture), but it also has occurred in liver transplant recipients and in patients with primary adrenal or metastatic tumors. In addition, unilateral adrenal hemorrhage is associated, albeit infrequently, with otherwise uncomplicated pregnancy, neurofibromatosis 1, or long-term nonsteroidal anti-inflammatory drug (NSAID) use. There have been rare reports of idiopathic, spontaneous, unilateral adrenal hemorrhage.

  • Unilateral adrenal hemorrhage secondary to blunt trauma more often involves the right adrenal. Liver hematomas and rib fractures commonly occur in these patients as well. Unilateral adrenal hemorrhage occurs in 2% of patients with penetrating trauma.
  • Right adrenal hemorrhage was found in 2% of liver transplant recipients in one study, and it also was reported in 10% of children dying early after orthotopic liver transplantation. In these patients, intraoperative ligation of the right adrenal vein, performed after a limited resection of the recipient's inferior vena cava, has sometimes resulted in venous infarction and adrenal hemorrhage.
  • Unilateral adrenal hemorrhage was described in patients with primary adrenal or metastatic tumors, representing hemorrhagic tumor infarction. Primary adrenal tumors associated with adrenal hemorrhage include adrenal adenomas, adrenocortical carcinomas, and pheochromocytomas. In addition, adrenal hemorrhage has been described in patients with metastatic hepatocellular carcinoma or with lung or gastric adenocarcinoma. [11]
  • In isolated cases, unilateral adrenal hemorrhage may occur in association with long-term NSAID, otherwise uncomplicated pregnancy, and neurofibromatosis 1. [12]
  • Idiopathic, unilateral adrenal hemorrhage is a rare entity that either may have an acute presentation (eg, idiopathic adrenal rupture) or may present as an asymptomatic adrenal mass. [13]
Contributor Information and Disclosures

Nicholas A Tritos, MD, DSc, MMSc, FACP, FACE Associate Professor of Medicine, Harvard Medical School; Associate in Medicine, Neuroendocrine Clinical Center, Massachusetts General Hospital

Nicholas A Tritos, MD, DSc, MMSc, FACP, FACE is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Medical Association, Endocrine Society, Massachusetts Medical Society, Pituitary Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Consultant for Bluebird bio; Ipsen<br/>Received research grant from: Ipsen; Pfizer; Novo Nordisk; Novartis<br/>Spouse received salary from Pfizer, Inc for employment.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS Professor of Medicine (Endocrinology, Adj), Johns Hopkins School of Medicine; Affiliate Research Professor, Bioinformatics and Computational Biology Program, School of Computational Sciences, George Mason University; Principal, C/A Informatics, LLC

Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Nutrition, American Society for Bone and Mineral Research, International Society for Clinical Densitometry, American College of Endocrinology, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Informatics Association, Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Additional Contributors

Dimitris A Papanicolaou, MD 

Dimitris A Papanicolaou, MD is a member of the following medical societies: American College of Physicians, Endocrine Society, Royal Society of Medicine

Disclosure: Nothing to disclose.

  1. Vella A, Nippoldt TB, Morris JC 3rd. Adrenal hemorrhage: a 25-year experience at the Mayo Clinic. Mayo Clin Proc. 2001 Feb. 76(2):161-8. [Medline].

  2. Ketha S, Smithedajkul P, Vella A, Pruthi R, Wysokinski W, McBane R. Adrenal haemorrhage due to heparin-induced thrombocytopenia. Thromb Haemost. 2013 Feb 7. 109(4):[Medline].

  3. Tormos LM, Schandl CA. The Significance of Adrenal Hemorrhage: Undiagnosed Waterhouse-Friderichsen Syndrome, A Case Series. J Forensic Sci. 2013 Mar 4. [Medline].

  4. Adem PV, Montgomery CP, Husain AN, et al. Staphylococcus aureus sepsis and the Waterhouse-Friderichsen syndrome in children. N Engl J Med. 2005 Sep 22. 353(12):1245-51. [Medline]. [Full Text].

  5. Pianta M, Varma DK. Bilateral spontaneous adrenal haemorrhage complicating acute pancreatitis. Australas Radiol. 2007 Apr. 51(2):172-4. [Medline].

  6. Gutenberg A, Lange B, Gunawan B, et al. Spontaneous adrenal hemorrhage: a little-known complication of intracranial tumor surgery. Case report. J Neurosurg. 2007 Jun. 106(6):1086-8. [Medline].

  7. Rosenberger LH, Smith PW, Sawyer RG, Hanks JB, Adams RB, Hedrick TL. Bilateral adrenal hemorrhage: The unrecognized cause of hemodynamic collapse associated with heparin-induced thrombocytopenia. Crit Care Med. 2011 Apr. 39(4):833-8. [Medline]. [Full Text].

  8. Arnason JA, Graziano FM. Adrenal insufficiency in the antiphospholipid antibody syndrome. Semin Arthritis Rheum. 1995 Oct. 25(2):109-16. [Medline].

  9. Caron P, Chabannier MH, Cambus JP, et al. Definitive adrenal insufficiency due to bilateral adrenal hemorrhage and primary antiphospholipid syndrome. J Clin Endocrinol Metab. 1998 May. 83(5):1437-9. [Medline]. [Full Text].

  10. Ramon I, Mathian A, Bachelot A, et al. Primary Adrenal Insufficiency Due to Bilateral Adrenal Hemorrhage-Adrenal Infarction in the Antiphospholipid Syndrome: Long-Term Outcome of 16 Patients. J Clin Endocrinol Metab. 2013 Jun 19. [Medline].

  11. Vasinanukorn P, Rerknimitr R, Sriussadaporn S, et al. Adrenal hemorrhage as the first presentation of hepatocellular carcinoma. Intern Med. 2007. 46(21):1779-82. [Medline]. [Full Text].

  12. Gavrilova-Jordan L, Edmister WB, Farrell MA, et al. Spontaneous adrenal hemorrhage during pregnancy: a review of the literature and a case report of successful conservative management. Obstet Gynecol Surv. 2005 Mar. 60(3):191-5. [Medline].

  13. Marti JL, Millet J, Sosa JA, Roman SA, Carling T, Udelsman R. Spontaneous adrenal hemorrhage with associated masses: etiology and management in 6 cases and a review of 133 reported cases. World J Surg. 2012 Jan. 36(1):75-82. [Medline].

  14. Shah HR, Love L, Williamson MR, et al. Hemorrhagic adrenal metastases: CT findings. J Comput Assist Tomogr. 1989 Jan-Feb. 13(1):77-81. [Medline].

  15. Sinelnikov AO, Abujudeh HH, Chan D, et al. CT manifestations of adrenal trauma: experience with 73 cases. Emerg Radiol. 2007 Mar. 13(6):313-8. [Medline].

  16. Tan GX, Sutherland T. Adrenal congestion preceding adrenal hemorrhage on CT imaging: a case series. Abdom Radiol (NY). 2016 Feb. 41 (2):303-10. [Medline].

  17. Itoh K, Yamashita K, Satoh Y, et al. MR imaging of bilateral adrenal hemorrhage. J Comput Assist Tomogr. 1988 Nov-Dec. 12(6):1054-6. [Medline].

  18. Bhatia KS, Ismail MM, Sahdev A, et al. (123)I-metaiodobenzylguanidine (MIBG) scintigraphy for the detection of adrenal and extra-adrenal phaeochromocytomas: CT and MRI correlation. Clin Endocrinol (Oxf). 2008 Apr 3. [Medline].

  19. Arlt W, Callies F, van Vlijmen JC, et al. Dehydroepiandrosterone replacement in women with adrenal insufficiency. N Engl J Med. 1999 Sep 30. 341(14):1013-20. [Medline]. [Full Text].

  20. Jahangir-Hekmat M, Taylor HC, Levin H, et al. Adrenal insufficiency attributable to adrenal hemorrhage: long-term follow-up with reference to glucocorticoid and mineralocorticoid function and replacement. Endocr Pract. 2004 Jan-Feb. 10(1):55-61. [Medline].

  21. Monticone S, Satoh F, Dietz AS, et al. Clinical Management and Outcomes of Adrenal Hemorrhage Following Adrenal Vein Sampling in Primary Aldosteronism. Hypertension. 2016 Jan. 67 (1):146-52. [Medline].

  22. Espinosa G, Santos E, Cervera R, et al. Adrenal involvement in the antiphospholipid syndrome: clinical and immunologic characteristics of 86 patients. Medicine (Baltimore). 2003 Mar. 82(2):106-18. [Medline].

  23. Hiroi N, Yanagisawa R, Yoshida-Hiroi M, et al. Retroperitoneal hemorrhage due to bilateral adrenal metastases from lung adenocarcinoma. J Endocrinol Invest. 2006 Jun. 29(6):551-4. [Medline].

  24. Schuchmann JA, Friedman PA. Bilateral adrenal hemorrhage: an unusual complication after bilateral total knee arthroplasty. Am J Phys Med Rehabil. 2005 Nov. 84(11):899-903. [Medline].

  25. Shifren JL. The role of androgens in female sexual dysfunction. Mayo Clin Proc. 2004 Apr. 79(4 Suppl):S19-24. [Medline].

  26. Guarner J, Paddock CD, Bartlett J, Zaki SR. Adrenal gland hemorrhage in patients with fatal bacterial infections. Mod Pathol. 2008 Sep. 21(9):1113-20. [Medline].

  27. Totan M. Adrenal hemorrhage due to vitamin-K deficiency. Indian J Pediatr. 2002 Jan. 69(1):99-100. [Medline].

  28. Vasinanukorn P, Rerknimitr R, Sriussadaporn S, Wisedopas N, Kongkam P, Chaopapsomkul B, et al. Adrenal hemorrhage as the first presentation of hepatocellular carcinoma. Intern Med. 2007. 46(21):1779-82. [Medline].

  29. Joseph UA, Barron BJ, Wan DQ. (18)F-Fluorodeoxy glucose (FDG) uptake in nontraumatic bilateral adrenal hemorrhage secondary to heparin-associated thrombocytopenia syndrome (HATS) - a case report. Clin Imaging. 2007 Mar-Apr. 31(2):137-40. [Medline].

  30. Wani MS, Naikoo ZA, Malik MA, Bhat AH, Wani MA, Qadri SA. Spontaneous adrenal hemorrhage during pregnancy: review of literature and case report of successful conservative management. J Turk Ger Gynecol Assoc. 2011. 12(4):263-5. [Medline]. [Full Text].

  31. Noviello C, Cobellis G, Muzzi G, Pieroni G, Amici G, Martino A. Neonatal adrenal hemorrhage presenting as contralateral scrotal ematoma. Minerva Pediatr. 2007 Apr. 59(2):157-9. [Medline].

  32. Simon DR, Palese MA. Clinical update on the management of adrenal hemorrhage. Curr Urol Rep. 2009 Jan. 10(1):78-83. [Medline].

  33. Nimkin K, Teeger S, Wallach MT, DuVally JC, Spevak MR, Kleinman PK. Adrenal hemorrhage in abused children: imaging and postmortem findings. AJR Am J Roentgenol. 1994 Mar. 162(3):661-3. [Medline].

  34. Chatterjee C, Khan D, das S, De U. Giant adrenal hemorrhagic cyst: An unusual abdominal lump. South Asian J Cancer. 2013 Jul. 2(3):141. [Medline]. [Full Text].

  35. Taguchi T, Inoue K, Terada Y. Concentric-ring sign in adrenal hemorrhage. Endocrine. 2014 Mar 8. [Medline].

  36. Schrank Y, Madeira M. Massive: hemorrhagic adrenal pseudocyst. Am J Med. 2014 May 6. [Medline].

  37. Repko BM, Tulchinsky M. Increased F-18 FDG uptake in resolving atraumatic bilateral adrenal hemorrhage (hematoma) on PET/CT. Clin Nucl Med. 2008 Sep. 33(9):651-3. [Medline].

  38. Rajamanickam A, Patel P, Anbazhagan P, Harte B. A life threatening complication of anticoagulation prophylaxis-bilateral adrenal hemorrhage. J Hosp Med. 2009 Nov. 4(9):E25-7. [Medline].

  39. You JS, Chung SP, Park YS, Chung HS, Lee HS, Yu JS. Isolated adrenal hemorrhage after minor blunt trauma. Am J Emerg Med. 2007 Oct. 25(8):984.e5-6. [Medline].

  40. Saad AF, Ford KL 3rd, Deprisco G, Smerud MJ. Adrenomegaly and septic adrenal hemorrhage (Waterhouse-Friderichsen syndrome) in the setting of congenital adrenal hyperplasia. Proc (Bayl Univ Med Cent). 2013 Jul. 26(3):268-9. [Medline]. [Full Text].

  41. Zhu X, van der Schaaf IC, van der Valk JA, Bartelink AK, Nix M. Acute adrenal insufficiency due to bilateral adrenal hemorrhage. JBR-BTR. 2011 Jan-Feb. 94(1):19-20. [Medline].

  42. Anagnostopoulos A, Sharma S. Spontaneous adrenal haemorrhage in pregnancy. BMJ Case Rep. 2011 Sep 13. 2011:[Medline]. [Full Text].

  43. Winter AG, Ramasamy R. Bilateral adrenal hemorrhage due to heparin-induced thrombocytopenia following partial nephrectomy - a case report. F1000Res. 2014. 3:24. [Medline]. [Full Text].

  44. Imga NN, Tutuncu Y, Tuna MM, Aycicek Dogan B, Berker D, Guler S. Idiopathic spontaneous adrenal hemorrhage in the third trimester of pregnancy. Case Rep Med. 2013. 2013:912494. [Medline]. [Full Text].

  45. Ohishi A, Ueno D, Ogata T. Glucose-6-phosphate dehydrogenase deficiency and adrenal hemorrhage in a filipino neonate with hyperbilirubinemia. AJP Rep. 2013 May. 3(1):5-8. [Medline]. [Full Text].

  46. Carter JS, Kothari R, Jonson AL. Idiopathic Adrenal Hemorrhage in a Patient with Gestational Trophoblastic Neoplasia. J Gynecol Surg. 2011. 27(1):53-55. [Medline]. [Full Text].

  47. Lau KK, Fernandez y Garcia E, Kwan WY, Albrecht L, Stein-Wexler R. Bilateral renal venous thrombosis and adrenal hemorrhage: sequential prenatal US with postnatal recovery. Pediatr Radiol. 2007 Sep. 37(9):912-5. [Medline].

  48. Adorisio O, Mattei R, Ciardini E, Centonze N, Noccioli B. Neonatal adrenal hemorrhage mimicking an acute scrotum. J Perinatol. 2007 Feb. 27(2):130-2. [Medline].

  49. Gutenberg A, Lange B, Gunawan B, Larsen J, Bruck W, Rohde V, et al. Spontaneous adrenal hemorrhage: a little-known complication of intracranial tumor surgery. Case report. J Neurosurg. 2007 Jun. 106(6):1086-8. [Medline].

  50. Picolos MK, Nooka A, Davis AB, Raval B, Orlander PR. Bilateral adrenal hemorrhage: an overlooked cause of hypotension. J Emerg Med. 2007 Feb. 32(2):167-9. [Medline].

  51. Mutlu M, Karagüzel G, Aslan Y, Cansu A, Okten A. Adrenal hemorrhage in newborns: a retrospective study. World J Pediatr. 2011 Nov. 7(4):355-7. [Medline].

  52. Canacci AM, MacLennan GT. Adrenal hemorrhage. J Urol. 2007 Jul. 178(1):284. [Medline].

  53. Girgis CM, Cole L, Champion BL. Bilateral adrenal haemorrhage in a critically ill patient. Crit Care Resusc. 2011 Jun. 13(2):123-4. [Medline].

  54. Best M, Palmer K, Jones QC, Wathen CG. Acute adrenal failure following anticoagulation with dabigatran after hip replacement and thrombolysis for massive pulmonary embolism. BMJ Case Rep. 2013 Jan 11. 2013:[Medline].

  55. Gonen MS, Ipekci SH, Govec N, Ozbek O. Polycythaemia vera presented with bilateral adrenal haemorrhage and adrenal insufficiency: a case report. Acta Clin Belg. 2011 Mar-Apr. 66(2):132-3. [Medline].

  56. Saberi S, Esfandiari NH. Bilateral adrenal masses. Cleve Clin J Med. 2012 Dec. 79(12):841-2. [Medline].

  57. Untereiner O, Charpentier C, Grignon B, Welfringer P, Garric J, Mertes PM. Adrenal trauma: medical and surgical emergency. Emerg Med J. 2013 Apr. 30(4):329-30. [Medline].

  58. Perl S, Kotz L, Keil M, Patronas NJ, Stratakis CA. Calcified adrenals associated with perinatal adrenal hemorrhage and adrenal insufficiency. J Clin Endocrinol Metab. 2007 Mar. 92(3):754. [Medline].

  59. Lertsburapa T, Vargas D, Lambert-Messerlian G, Tantravahi U, Gundogan F, DeLaMonte S, et al. Lethal Hypoplasia and Developmental Anomalies of the Lungs in a Newborn with Intrauterine Adrenal Hemorrhage and Cerebral infarcts: A Proposed Pulmonary Disruption Sequence. Pediatr Dev Pathol. 2014 Jun 27. [Medline].

  60. Roupakias S, Papoutsakis M, Mitsakou P. Blunt adrenal gland trauma in the pediatric population. Asian J Surg. 2011 Jul. 34(3):103-10. [Medline].

  61. Bakaeen FG, Walkes JC, Reardon MJ. Heparin-induced thrombocytopenia associated with bilateral adrenal hemorrhage after coronary artery bypass surgery. Ann Thorac Surg. 2005 Apr. 79(4):1388-90. [Medline].

  62. Sacerdote MG, Johnson PT, Fishman EK. CT of the adrenal gland: the many faces of adrenal hemorrhage. Emerg Radiol. 2012 Jan. 19(1):53-60. [Medline].

  63. Kurtz LE, Yang S. Bilateral adrenal hemorrhage associated with heparin induced thrombocytopenia. Am J Hematol. 2007 Jun. 82(6):493-4. [Medline].

  64. Kyoda Y, Tanaka T, Maeda T, Masumori N, Tsukamoto T. Adrenal hemorrhagic pseudocyst as the differential diagnosis of pheochromocytoma--a review of the clinical features in cases with radiographically diagnosed pheochromocytoma. J Endocrinol Invest. 2013 Oct. 36(9):707-11. [Medline].

  65. Roupakias S, Papoutsakis M, Tsikopoulos G. Adrenal injuries following blunt abdominal trauma in children: report of two cases. Ulus Travma Acil Cerrahi Derg. 2012 Mar. 18(2):171-4. [Medline].

  66. Bockorny B, Posteraro A, Bilgrami S. Bilateral spontaneous adrenal hemorrhage during pregnancy. Obstet Gynecol. 2012 Aug. 120(2 Pt 1):377-81. [Medline].

  67. Namias N. Chance favors the prepared mind: the association between heparin-induced thrombocytopenia and bilateral adrenal hemorrhage. Crit Care Med. 2011 Apr. 39(4):912-3. [Medline].

  68. Chow VW, Abnousi F, Huddleston JI, Lin LH. Heparin-induced thrombocytopenia after total knee arthroplasty, with subsequent adrenal hemorrhage. J Arthroplasty. 2012 Aug. 27(7):1413.e15-8. [Medline].

  69. Knorr M, Evans D. Bedside ultrasound of acute adrenal hemorrhage. Am J Emerg Med. 2012 Nov. 30(9):2088.e1-2. [Medline].

  70. Tormos LM, Schandl CA. The significance of adrenal hemorrhage: undiagnosed Waterhouse-Friderichsen syndrome, a case series. J Forensic Sci. 2013 Jul. 58(4):1071-4. [Medline].

  71. Benavente-Chenhalls LA, Vella A, Farley DR, Thompson GB, Grant CS, Richards ML. Malignant adrenal neoplasm masquerading as worrisome adrenal hemorrhage. Ann Surg Oncol. 2010 Oct. 17(10):2710-3. [Medline].

  72. Marti JL, Millet J, Sosa JA, Roman SA, Carling T, Udelsman R. Spontaneous adrenal hemorrhage with associated masses: etiology and management in 6 cases and a review of 133 reported cases. World J Surg. 2012 Jan. 36(1):75-82. [Medline].

  73. Hsieh S, White PC. Presentation of primary adrenal insufficiency in childhood. J Clin Endocrinol Metab. 2011 Jun. 96(6):E925-8. [Medline].

  74. Lattin GE Jr, Sturgill ED, Tujo CA, Marko J, Sanchez-Maldonado KW, Craig WD, et al. From the radiologic pathology archives: Adrenal tumors and tumor-like conditions in the adult: radiologic-pathologic correlation. Radiographics. 2014 May-Jun. 34(3):805-29. [Medline].

  75. Boneschansker L, Nijland M, Glaudemans AW, van der Meulen SB, Kluin PM, Dullaart RP. Adrenal hemorrhage causing adrenal insufficiency in a patient with antiphospholipid syndrome: increased adrenal 18F-FDG uptake. J Clin Endocrinol Metab. 2012 Sep. 97(9):3014-5. [Medline].

  76. Jordan E, Poder L, Courtier J, Sai V, Jung A, Coakley FV. Imaging of nontraumatic adrenal hemorrhage. AJR Am J Roentgenol. 2012 Jul. 199(1):W91-8. [Medline].

  77. Imachi H, Murao K, Yoshimoto T, Sugimoto M, Kakehi Y, Hayashi T, et al. Idiopathic unilateral adrenal hemorrhage in an elderly patient. Endocrine. 2010 Apr. 37(2):249-52. [Medline].

  78. Rosenberger LH, Smith PW, Sawyer RG, Hanks JB, Adams RB, Hedrick TL. Bilateral adrenal hemorrhage: the unrecognized cause of hemodynamic collapse associated with heparin-induced thrombocytopenia. Crit Care Med. 2011 Apr. 39(4):833-8. [Medline]. [Full Text].

  79. Ruffini E, De Petris L, Zorzi G, Paoletti P, Mambelli G, Carlucci A. Two cases of neonatal adrenal hemorrhage presenting with persistent jaundice. Pediatr Med Chir. 2013 Nov-Dec. 35(6):285-7. [Medline].

  80. Manganaro L, Al Ansari N, Barchetti F, Saldari M, Vitturini C, Glorioso M, et al. Bilateral adrenal hemorrhage in a patient with myelodysplastic syndrome: value of MRI in the differential diagnosis. Case Rep Radiol. 2013. 2013:479836. [Medline]. [Full Text].

  81. Chronopoulos E, Nikolaou VS, Masgala A, Kaspiris A, Babis GC. Unilateral adrenal hemorrhage after total knee arthroplasty. Orthopedics. 2014 May. 37(5):e508-11. [Medline].

  82. Bhattacharya M, Yeh BM, Qayyum A, Coakley FV. Case 81: antiphospholipid antibody syndrome with adrenal hemorrhage and Budd-Chiari syndrome. Radiology. 2005 Apr. 235(1):53-5. [Medline].

  83. Wang J, Packer CD. Acute abdominal pain after intercourse: adrenal hemorrhage as the first sign of metastatic lung cancer. Case Rep Med. 2014. 2014:612036. [Medline]. [Full Text].

  84. Ramon I, Mathian A, Bachelot A, et al. Primary adrenal insufficiency due to bilateral adrenal hemorrhage-adrenal infarction in the antiphospholipid syndrome: long-term outcome of 16 patients. J Clin Endocrinol Metab. 2013 Aug. 98(8):3179-89. [Medline].

Computed tomographic (CT) scans of the abdomen show normal adrenal glands several months before the onset of hemorrhage (upper panel) and enlarged adrenals 2 weeks after an acute episode of bilateral adrenal hemorrhage (lower panel). The attenuation of the adrenal glands, indicated by arrows, is increased after the acute event. Reproduced from Rao RH, Vagnucci AH, Amico JA: Bilateral massive adrenal hemorrhage: early recognition and treatment. Ann Intern Med. Feb 1 1989;110(3):227-35 with permission from the journal.
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