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Adrenal hemorrhage
Other Resources UpToDate PubMed

Adrenal hemorrhage

Contributors: Benjamin L. Mazer MD, MBA, Marilyn Augustine MD
Other Resources UpToDate PubMed


Deteriorating condition of bleeding and necrosis of all 3 cortical layers of the bilateral adrenal glands, possibly in combination with adrenal infarction and adrenal vein thrombosis. It can cause a life-threatening acute adrenal crisis characterized by hypotension, shock, and death if not immediately treated. Symptoms include pain (lumbar, epigastric, pelvic, flank, and thoracic), fatigue, fever, epigastric findings (nausea, vomiting, loss of appetite), and neurologic findings (disorientation, confusion). Risk factors for adrenal hemorrhage include anticoagulant therapy, heparin-induced thrombocytopenia, trauma, sepsis, severe stress, postoperative state, and adverse drug reactions.

Treatment may include preemptive steroid therapy, resolving acute crisis, rehydration, and bed rest. Surgery is only recommended when severe adrenal trauma or tumors are involved.


E27.49 – Other adrenocortical insufficiency

49111001 – Adrenal hemorrhage

Differential Diagnosis & Pitfalls

  • Addison disease
  • Shock (Septic shock, Cardiogenic shock, etc)
  • Congenital adrenal hyperplasia
  • Sarcoidosis
  • Tuberculosis
  • Histoplasmosis
  • Trauma
  • Hemochromatosis
  • Drug side effect (insulin, withdrawal of corticosteroids)
  • Amyloidosis (AL amyloidosis, AA amyloidosis)
  • Adrenoleukodystrophy
  • Malignancy (particularly metastasis, primary Adrenocortical carcinoma, Renal cell carcinoma, Pituitary tumor)
  • Hypopituitarism

Best Tests

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Updated:08/11/2016
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Adrenal hemorrhage
A medical illustration showing key findings of Adrenal hemorrhage : Diarrhea, Vomiting, Hyperkalemia, Hypoglycemia, Anticoagulant, BP decreased, Na decreased
Copyright © 2024 VisualDx®. All rights reserved.