Adrenal hemorrhage (AH) is acute blood loss from a ruptured vessel of the adrenal glands above the kidneys.
It is a rare, yet potentially fatal event that could be caused by trauma and multiple non-traumatic conditions.[1] Despite the unclear etiology, there are several risk factors of adrenal hemorrhage, including birth trauma, sepsis, and hemorrhagic disorders.[2] Anoxia and sepsis are the most frequent causes at birth, while adrenal insufficiency often manifests in neonates.[3] Adrenal haemorrhage has been reported during COVID-19 infection and following Oxford–AstraZeneca COVID-19 vaccination.[4]
According to the degree and rate of hemorrhage,[1] its clinical manifestations can vary widely. The non-specific signs and symptoms in prominent underlying diseases often prevent prompt recognition and proper treatment of the condition, which may result in adrenal crisis, shock, and death.[5] Although the mortality rate varies with the severity of the underlying inductive disease, adrenal hemorrhage is related to 15% of the deaths.[5]
In the US, the incidence rate is reported to be 0.3-1.8% based on unselected cases in autopsy studies.[5] In terms of age group, higher prevalence is found among neonates, with an incidence rate of 0.17% in infant autopsies and 3% in infant abdominal ultrasound examination.[6]
Diagnosis in the early phase is critical, though it is relatively rare due to non-characteristic clinical presentation and laboratory findings.[7] Imaging and laboratory studies are often employed for diagnosis and surveillance. Non-operative management has taken over surgical exploration and has become the main approach to treating both traumatic and non-traumatic adrenal hemorrhage.
^ abSimon DR, Palese MA (January 2009). "Clinical update on the management of adrenal hemorrhage". Current Urology Reports. 10 (1): 78–83. doi:10.1007/s11934-009-0014-y. PMID 19116100. S2CID 19336379.
^Donovan BO, Ramji F, Frimberger D, Kropp BP (2010-01-01). "Chapter 54: Neonatal Urologic Emergencies". In Gearhart JP, Rink RC, Mouriquand PD (eds.). Pediatric Urology (Second ed.). W.B. Saunders. pp. 709–719. doi:10.1016/b978-1-4160-3204-5.00054-2. ISBN 978-1-4160-3204-5. Retrieved 2020-04-06.
^Gleason CA, Juul SE (21 November 2017). Avery's diseases of the newborn (Tenth ed.). Philadelphia, PA. ISBN 978-0-323-40172-2. OCLC 1013816550.{{cite book}}: CS1 maint: location missing publisher (link)
^Elhassan, Yasir S.; Iqbal, Fizzah; Arlt, Wiebke; Baldeweg, Stephanie E.; Levy, Miles; Stewart, Paul M.; Wass, John; Pavord, Sue; Aled Rees, D.; Ronchi, Cristina L. (5 February 2023). "COVID-19-related adrenal haemorrhage: Multicentre UK experience and systematic review of the literature". Clinical Endocrinology. 98 (6): 766–778. doi:10.1111/cen.14881. ISSN 0300-0664. PMID 36710422. S2CID 256387753.
^ abcTritos NA (Oct 2018). "Adrenal Hemorrhage". Medscape. WebMD LLC. Retrieved 30 March 2020.
^Qureshi UA, Ahmad N, Rasool A, Choh S (October 2009). "Neonatal adrenal hemorrhage presenting as late onset neonatal jaundice". Journal of Indian Association of Pediatric Surgeons. 14 (4): 221–3. doi:10.4103/0971-9261.59607. PMC 2858887. PMID 20419026.
^Di Serafino M, Severino R, Coppola V, Gioioso M, Rocca R, Lisanti F, Scarano E (September 2017). "Nontraumatic adrenal hemorrhage: the adrenal stress". Radiology Case Reports. 12 (3): 483–487. doi:10.1016/j.radcr.2017.03.020. PMC 5551907. PMID 28828107.
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