Adrenal Hemorrhage

Adrenal hemorrhage is an uncommon disorder characterized by bleeding into the suprarenal glands. The hematoma may be unilateral or bilateral, and the clinical presentation can range from nonspecific abdominal pain to catastrophic cardiovascular collapse. The etiologies for this unusual disorder are diverse. Potential causes include blunt abdominal trauma, septicemia, coagulopathies, anti-coagulant use, pregnancy, stress, antiphospholipid syndrome, and essential thrombocytosis.[1][2][3][2][4][5][6][7] A high index of clinical suspicion is necessary for prompt diagnosis. A plethora of clinical presentations makes the diagnosis challenging. The signs and symptoms range from nonspecific abdominal pain to acute adrenal insufficiency, depending on the site and extent of hemorrhage. Imaging and biochemical evaluation provide the mainstay for diagnosis. The adrenal glands are a pair of endocrine organs located in the retroperitoneum on the upper poles of the kidneys. They comprise two embryologically and functionally distinct parts, the outer mesodermally derived adrenal cortex, which produces glucocorticoids, mineralocorticoids, and adrenal androgens, and the inner adrenal medulla, which originates from the neural crest secretes catecholamines. The suprarenal glands are one of the most well-perfused organs in the human body. The superior, middle, and inferior adrenal arteries originate from the inferior phrenic artery, the abdominal aorta, and the renal artery, respectively, form the chief arterial supply. In contrast, the venous drainage is limited and often utilizing a single adrenal vein, which drains into the inferior vena cava on the right and the renal vein on the left. This difference between the arterial inflow and venous drainage may explain the anatomic predisposition to developing hemorrhagic infarction.[8]
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