Approach to the Patient with Adrenal Hemorrhage

Yasir Elhassan*, Cristina Ronchi, Piyumi Wijewickrama , Stephanie E Baldeweg

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Adrenal hemorrhage is an uncommon underrecognized condition that can be encountered in several clinical contexts. Diagnosing adrenal hemorrhage is challenging due to the non-specific clinical features. Therefore, it remains a diagnosis that is made serendipitously on imaging of acutely unwell patients rather than with prospective clinical suspicion. Adrenal hemorrhage can follow abdominal trauma or on a background of predisposing conditions such as adrenal tumors, sepsis, or coagulopathy. Adrenal hemorrhage is also increasingly reported in patients with COVID-19 infection and in the context of vaccine-induced immune thrombocytopenia and thrombosis, in both cases likely as a consequence of adrenal vein thrombosis. Unexplained abdominal pain with hemodynamic instability in a patient with a predisposing condition should alert the physician to the possibility of adrenal hemorrhage. Bilateral adrenal hemorrhage can lead to adrenal insufficiency and potentially fatal adrenal crisis without timely recognition and treatment. In this article, we highlight the clinical circumstances that are associated with higher risk of adrenal hemorrhage, encouraging clinicians to prospectively consider the diagnosis, and share a diagnostic and management strategy.
Original languageEnglish
Article numberdgac672
Number of pages12
JournalJournal of Clinical Endocrinology and Metabolism
Volume2022
Issue number00
Early online date21 Nov 2022
DOIs
Publication statusE-pub ahead of print - 21 Nov 2022

Keywords

  • adrenal apoplexy
  • adrenal crisis
  • adrenal incidentaloma
  • adrenal insufficiency
  • antiphospholipid syndrome
  • COVID-19

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