Adrenal hemorrhage: diagnostics, management, and treatment. Review and clinical update

Adrenal hemorrhage (AH) is a rare and often underdiagnosed condition that can present with nonspecific symptoms and may be life-threatening. Accurate diagnosis and tailored management are essential.

The aim of this paper was to review the literature on AH with emphasis on etiology, diagnostic approaches, management strategies, and methodological quality of available studies.

A structured search of the literature was performed. Forty-one relevant articles were included in the review. Risk of bias was assessed in 3 eligible studies (2 single-center series and 1 case series with literature review) using the Joanna Briggs Institute tools and adapted criteria.

Trauma accounted for the majority of AH cases. Nontraumatic etiologies included anticoagulation, infection, stress, and adrenal tumors, such as pheochromocytoma, adrenocortical carcinoma, and metastases. Computed tomography and magnetic resonance imaging were the key diagnostic modalities. Management strategies ranged from conservative observation and embolization to laparoscopic or open adrenalectomy, guided by hemodynamic stability, capsule integrity, and suspicion of malignancy. All assessed studies had moderate risk of bias due to retrospective design and limited sample size.

AH requires high clinical suspicion and structured imaging / endocrine evaluation. Open adrenalectomy is recommended in unstable patients, in the cases of capsule rupture, or when malignancy is suspected. In patients with hemorrhage confined to the adrenal capsule, laparoscopic adrenalectomy represents the preferred surgical approach. Larger prospective multicenter studies are warranted to establish standardized guidelines.