Medical Care

In patients with suspected acute adrenal hemorrhage, evaluation should take place in an inpatient setting, because acute adrenal insufficiency may occur. However, most of these patients are acutely ill and already are in the hospital at the time of acute adrenal hemorrhage.

In asymptomatic patients presenting with an adrenal mass or calcifications, outpatient evaluation is appropriate.

Medical therapies are used to replace adrenal function, to provide vital function support as needed, to treat the underlying condition(s), and to correct fluid, electrolyte, and red cell mass deficits.

Surgical Care

Adrenalectomy (open or laparoscopic) may be performed.

Surgery generally is not required in cases of nontraumatic adrenal hemorrhage, except in patients with primary adrenal tumors or in rare cases, of extensive retroperitoneal hemorrhage secondary to adrenal hemorrhage.
In traumatic adrenal hemorrhage cases, surgery may be necessary for the treatment of associated injuries, the exploration of penetrating wounds, or the control of bleeding.

Consultations

Consultations include the following:

Endocrinologist
Interventional radiologist
Urologist or surgeon
Cardiologist, infectious diseases specialist, or other specialists as needed, to optimize the management of the underlying condition(s)

Diet

Critically ill patients with suspected adrenal hemorrhage are kept on nothing by mouth (NPO) status.

Patients with acute adrenal hemorrhage also may be kept NPO, depending on the presence of symptoms, such as vomiting.

In cases of chronic adrenal hemorrhage complicated by adrenal insufficiency, patients must maintain adequate hydration and salt intake. Liberal salt intake is contraindicated in the presence of hypertension, congestive heart failure, or renal failure.

Activity

Patients with suspected acute adrenal hemorrhage are kept on bed rest.

Activity is unrestricted after resolution of the acute event; however, patients must receive appropriate adrenal replacement therapy. Depending on the underlying condition(s), activity restrictions may still be necessary.

Medication

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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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