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Adrenal Hemorrhage: A Comprehensive Analysis of a Heterogeneous Entity-Etiology, Presentation, Management, and
Prerna Dogra1, Mrunal Chinthapalli2, Rashi Sandooja2
1Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN; Division of Endocrinology, Diabetes, and Metabolism, University of Wisconsin School of Medicine and Public Health, Madison.
Insights
Adrenal hemorrhage (AH) often presents as an incidental unilateral finding, typically linked to surgery or trauma. Bilateral adrenal hemorrhage is rare, often indicating coagulopathy and leading to adrenal insufficiency.
Area of Science:
- Endocrinology
- Radiology
- Surgical Complications
Background:
- Adrenal hemorrhage (AH) is a condition affecting the adrenal glands.
- Understanding its causes, presentation, and outcomes is crucial for patient management.
Purpose of the Study:
- To investigate the etiology, clinical presentation, management strategies, and patient outcomes associated with adrenal hemorrhage.
- To differentiate characteristics and outcomes of unilateral versus bilateral adrenal hemorrhage.
Main Methods:
- A longitudinal study was conducted on adult patients with radiologically confirmed adrenal hemorrhage.
- Data were collected from January 1, 2017, to December 31, 2021.
Main Results:
- Of 363 patients, 93% had unilateral AH and 7% bilateral AH. Common causes included postoperative complications (41%) and trauma (30%).
- Incidental findings accounted for 42% of cases. Bilateral AH was associated with coagulopathy (44%) and adrenal insufficiency (72%).
- Complete resolution occurred in 63% of cases with follow-up imaging; no deaths were attributed to AH.
Conclusions:
- Adrenal hemorrhage frequently presents as an incidental, unilateral finding, often resulting from postoperative complications or trauma.
- Bilateral adrenal hemorrhage is uncommon but strongly associated with coagulopathy and subsequent primary adrenal insufficiency.
Objective:
To investigate the etiology, presentation, management, and outcomes of patients with adrenal hemorrhage (AH).
Patients And Methods:
Longitudinal study of consecutive adult patients with radiologically confirmed AH (January 1, 2017, through December 31, 2021).
Results:
Of the 363 patients with AH (median age, 62 years [interquartile range (IQR, 52-70 years]; 128 women [35%]), 338 (93%) had unilateral AH and 25 (7%) had bilateral AH. It was discovered incidentally in 152 patients (42%) and during the evaluation of trauma in 103 (28%), abdominal/back pain in 90 (25%), critical illness in 13 (4%), and symptoms of adrenal insufficiency in 5 (1%). Etiologies included postoperative complications in 150 patients (41%), trauma in 107 (30%), coagulopathy in 22 (6%), anticoagulant/antiplatelet therapy in 39 (11%), adrenal neoplasm in 22 (6%), and sepsis in 11, (3%). Overall, 165 patients (46%) were hospitalized, and no deaths occurred due to AH. Median (IQR) baseline AH size was 34 mm (24-40 mm) on the right and 29 mm (22-37 mm) on the left. Among 246 patients with follow-up imaging, AH resolution was complete in 155 (63%) and incomplete in 74 (30%) at a median of 15 months (IQR, 6-31 months). Patients with bilateral AH were more likely to have underlying coagulopathy (44% vs 3%) and to develop primary adrenal insufficiency (72% vs 0%) than those with unilateral AH (P<.001).
Conclusion:
Often, AH presents as an incidental unilateral lesion with normal adrenal function, commonly attributed to postoperative complications or trauma. In contrast, bilateral AH is rare and typically linked to underlying coagulopathy, with primary adrenal insufficiency developing in most patients.
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