Adrenal Hemorrhage Medication

  • Author: Nicholas A Tritos, MD, DSc, MMSc, FACP, FACE; Chief Editor: George T Griffing, MD   more...
 
Updated: Jul 13, 2011
 

Medication Summary

Immediately after a serum sample (for cortisol assay) has been obtained, but without awaiting biochemical confirmation, glucocorticoids should be urgently administered to patients with suspected acute, bilateral adrenal hemorrhage in order to prevent or treat acute adrenal insufficiency.

In acutely ill patients, supportive therapy and specific treatments for the underlying condition(s) must be provided urgently as well.

After the acute adrenal hemorrhagic event, long-term glucocorticoid replacement with or without mineralocorticoid replacement therapy may be necessary, based on the results of adrenal function testing.

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Corticosteroids

Class Summary

Administered in a stress-dose regimen, these medications adequately replace glucocorticoid hormone requirements in patients with suspected acute, bilateral adrenal hemorrhage whose adrenal function may be compromised. After discharge, oral prednisone, hydrocortisone, or dexamethasone commonly is used. Only the former 2 glucocorticoids possess some mineralocorticoid properties, whereas dexamethasone is devoid of any such activity.

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Hydrocortisone (Solu-Cortef, Hydrocortone, Hydrocort)

 

Intravenous hydrocortisone, in conjunction with supportive measures, frequently is used and averts or adequately treats acute adrenal crisis.

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Prednisone (Deltasone, Meticorten, Orasone)

 

After discharge, oral prednisone commonly is used for maintenance. Possesses some mineralocorticoid properties.

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Dexamethasone (Decadron, AK-Dex)

 

In conjunction with supportive measures, it is used frequently and averts or adequately treats acute adrenal crisis. Preferred if a Cortrosyn stimulation test is planned soon after the patient has been stabilized, because it does not interfere in a cortisol assay. After discharge, dexamethasone commonly is used for maintenance.

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9-alpha-fludrocortisone (Florinef)

 

May be indicated in patients with a history of bilateral, extensive adrenal hemorrhage in order to replace mineralocorticoid hormone requirements, based on results of adrenal function testing. Therapy is unnecessary in (acutely ill) patients receiving more than 100 mg of hydrocortisone daily, because this dose also provides adequate mineralocorticoid replacement.

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Contributor Information and Disclosures
Author

Nicholas A Tritos, MD, DSc, MMSc, FACP, FACE  Assistant Professor of Medicine, Harvard Medical School; Assistant in Medicine, Neuroendocrine Unit, 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, and Pituitary Society

Disclosure: Pfizer, Inc Salary Employment

Specialty Editor Board

Dimitris A Papanicolaou, MD  Assistant Professor, Department of Medicine/Endocrinology, Emory University

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

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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 Endocrinology, American College of Nutrition, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Informatics Association, American Society for Bone and Mineral Research, Endocrine Society, and International Society for Clinical Densitometry

Disclosure: Nothing to disclose.

Mark Cooper, MBBS, PhD, FRACP  Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor 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, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

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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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