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.^[11]

A study by Diolombi et al indicated that the diagnosis of adrenocortical adenomas can be difficult in the setting of diffuse (>25%) hemorrhage of the adrenal glands, because malignancy and hemorrhage each cause marked adrenal enlargement.^[23]

The aforementioned study by Karwacka et al found that in 16 of the 23 adrenal hemorrhage patients (69.6%), workup revealing the condition stemmed from the discovery of adrenal incidentalomas.^[19]

Differential Diagnoses

Acute (surgical) abdomen
Adrenal calcifications
Adrenal Carcinoma
Adrenal Crisis
Adrenal Incidentaloma
Adrenal neuroblastoma
Granulomatous diseases
Myocardial Infarction
Pheochromocytoma
Septic Shock

Workup

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Media Gallery

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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