Adrenal haemorrhage

Overview

Diagram of adrenal blood flow

Adrenal haemorrhage is a rare but potentially life-threatening condition characterized by bleeding into the adrenal glands. The adrenal glands are small, triangular-shaped glands located on top of each kidney. They are responsible for producing a variety of hormones, including cortisol, aldosterone, and adrenaline.

Etiology

Adrenal haemorrhage can occur due to a variety of causes, including:

• Trauma: Physical injury to the abdomen or back can lead to bleeding in the adrenal glands.
• Sepsis: Severe infections can cause disseminated intravascular coagulation (DIC), leading to adrenal bleeding.
• Anticoagulation therapy: Medications that prevent blood clotting can increase the risk of bleeding.
• Adrenal vein thrombosis: Blockage of the adrenal vein can lead to increased pressure and subsequent bleeding.
• Neonatal stress: In newborns, stress during delivery can cause adrenal haemorrhage.

Pathophysiology

The adrenal glands have a rich blood supply, which makes them susceptible to bleeding. The adrenal cortex and adrenal medulla are supplied by numerous small arteries that branch from the aorta and renal arteries. When bleeding occurs, it can lead to the destruction of adrenal tissue and result in adrenal insufficiency.

Clinical Presentation

Symptoms of adrenal haemorrhage can vary depending on the extent of the bleeding and the underlying cause. Common symptoms include:

• Severe abdominal or flank pain
• Hypotension (low blood pressure)
• Fever
• Nausea and vomiting
• Confusion or altered mental status

Diagnosis

Diagnosis of adrenal haemorrhage is typically made using imaging studies such as:

• Computed tomography (CT) scan: Can reveal enlargement of the adrenal glands and areas of bleeding.
• Magnetic resonance imaging (MRI): Provides detailed images of the adrenal glands and surrounding structures.

Treatment

Treatment of adrenal haemorrhage depends on the underlying cause and the severity of the condition. Options include:

• Supportive care: Includes fluid resuscitation and blood transfusions if necessary.
• Hormone replacement therapy: If adrenal insufficiency occurs, replacement of hormones such as cortisol may be required.
• Surgical intervention: In cases of severe bleeding or complications, surgery may be necessary to remove the affected adrenal gland.

Prognosis

The prognosis for adrenal haemorrhage varies. Early diagnosis and treatment are crucial for a favorable outcome. If left untreated, adrenal haemorrhage can lead to adrenal crisis and be life-threatening.

Related Pages

• Adrenal gland
• Adrenal insufficiency
• Cushing's syndrome
• Addison's disease