Adrenal hemorrhage is a rather rare disorder with an unpredictable and non specific clinical picture; it can lead to acute adrenal crisis, shock, and even death, unless diagnosed promptly and treated immediately and correctly.
The signs and symptoms of adrenal hemorrhage are:
- Pain in the abdomen, pelvis, chest, flank, or back.
- Exhaustion and fatigue.
- Giddiness and light headedness.
- Muscle pains and joint pains.
- Nausea and vomiting.
- Symptoms associated with the underlying condition which is causing the hemorrhage will also be present.
- Seldom, the condition may be asymptomatic, presenting as an incidental finding during investigations.
Causes Of Adrenal Hemorrhage
Common causes for adrenal hemorrhage are:
- Infections – sepsis, wound infections, influenza, pneumonia, varicella, and malaria.
- Waterhouse-Friderichsen syndrome is seen as hemorrhagic necrosis of the viscera, including adrenal hemorrhage.
- Myocardial infarction, congestive cardiac failure, inflammatory bowel disease, acute pancreatitis, and cirrhosis are linked to adrenal hemorrhage.
- Coronary artery bypass graft surgery, hip joint replacement, intracranial surgery, and hepatic arterial chemo-embolization are procedures associated with bilateral adrenal hemorrhage.
- Toxemia of pregnancy, ante-partum or postpartum hemorrhage, spontaneous abortion, twisted ovarian cyst cause adrenal hemorrhage.
- Hemorrhagic diatheses, including anticoagulant use, thrombocytopenia, and vitamin K deficiency have been associated with bilateral adrenal hemorrhage cases.
- Arterial (pulmonary embolism, cerebro-vascular disorders, peripheral arterial embolism) and venous (deep venous thrombosis, superficial thrombo-phlebitis) causes have been associated with bilateral adrenal hemorrhage too.
- Treatment with ACTH for cases of multiple sclerosis or inflammatory bowel disease has in some cases been linked to bilateral adrenal hemorrhage.
- Blunt trauma / injury – such as vehicle accidents have been frequently associated with bilateral adrenal hemorrhage.
- Adrenal disorders such as – amyloidosis, granulomatous diseases, and metastatic tumors are important underlying conditions for hemorrhage.
- Adrenal hemorrhage has been seen in people who have had a liver transplantation. In these patients, intra-operative ligation of the right adrenal vein, carried out after a limited resection of the inferior vena cava, has been known to sometimes cause venous infarction and adrenal hemorrhage.
- Primary adrenal as well as metastatic tumor masses can trigger adrenal bleeding.
- In occasional cases, adrenal hemorrhage may occur in association with the prolonged usage of non steroidal anti-inflammatory drugs.
Treatment Options For Adrenal Hemorrhage
Evaluation of the case must take place in an in-patient set-up, given that, acute adrenal insufficiency can occur. On the other hand, most patients are acutely ill and have been already admitted to the hospital at the time of an adrenal hemorrhage.
- In asymptomatic patients presenting with an adrenal mass, out-patient assessment is done.
- Medical therapies are used to restore adrenal functioning, to proffer vital function support, to manage the underlying causative condition and to remedy fluid, electrolyte, and red cell mass insufficiency.
- Adrenalectomy may also need to be performed.
- By and large, surgical intervention is not needed in cases of non traumatic adrenal hemorrhage, except when patients have a primary adrenal tumor or in rare cases, of extensive retro-peritoneal hemorrhage secondary to adrenal hemorrhage.
- In traumatic adrenal hemorrhage, surgical intervention is usually required for the treatment of the injuries, to explore the penetrating wound, or to halt the bleeding.