Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Adrenal Hemorrhage Differential Diagnoses

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

Diagnostic Considerations

Spontaneous adrenal hemorrhage may occur in otherwise uncomplicated pregnancy in the absence of preeclampsia, trauma, or sepsis. Thus, adrenal hemorrhage should be considered in the differential diagnosis of abdominal or flank pain in pregnant women.

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

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.

References
  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].

Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.