Clinical update on the management of adrenal hemorrhage

Adrenal hemorrhage is a rare yet potentially life-threatening event that occurs both in traumatic conditions and in a variety of nontraumatic conditions. Clinical manifestations of adrenal hemorrhage can vary widely depending on the degree and rate of hemorrhage, as well as the amount of adrenal cortex compromised by hemorrhage. Although an isolated focal unilateral adrenal hemorrhage may present subclinically, massive bilateral adrenal hemorrhage may lead to rapid cardiovascular collapse and ultimately death if not diagnosed appropriately and treated quickly. Diagnosis of adrenal hemorrhage is often complicated by its nonspecific presentation and tendency to occur in the setting of acute illness and other complicating medical conditions. This article outlines the variety of clinical situations in which adrenal hemorrhage can occur, summarizes the appropriate diagnostic tests available, and reviews the appropriate management of adrenal hemorrhage.